The Impact of Intraoperative Echocardiography on Clinical Outcomes Following 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.

Download Full-text

Abstract 14873: Is There Difference in Clinical Outcomes Following Percutaneous Coronary Intervention (PCI) for Acute Coronary Syndrome (ACS) between Hospitals With and Without Onsite Cardiac Surgery Backup?

Circulation ◽

10.1161/circ.130.suppl_2.14873 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Tomonori Akasaka ◽

Seiji Hokimoto ◽

Noriaki Tabata ◽

Kenji Sakamoto ◽

Kenichi Tsujita ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Outcomes ◽

Primary Endpoint ◽

Proportional Hazards Model ◽

Cox Proportional Hazards Model ◽

Bleeding Complications ◽

Hospital Death ◽

Coronary Syndrome ◽

Significant Difference ◽

The Impact

Background: Based on 2011 ACCF/AHA/SCAI PCI guideline, it is recommended that PCI should be performed at hospital with onsite cardiac surgery. But, recent data suggests that there is no significant difference in clinical outcomes following primary or elective PCI between hospitals with and without onsite cardiac surgery. The proportion of PCI centers without onsite cardiac surgery comprises approximately more than half of all PCI centers in Japan. We examined the impact of with or without onsite cardiac surgery on clinical outcomes following PCI to ACS. Methods: From Aug 2008 to March 2011, subjects (n=2288) were enrolled from the Kumamoto Intervention Conference Study (KICS), which is a multicenter registry, and enrolling consecutive patients undergoing PCI in 15 centers in Japan. Patients were assigned to two groups treated in hospitals with (n=1954) or without (n=334) onsite cardiac surgery. Clinical events were followed up for 12 months. Primary endpoint was in-hospital death, cardiovascular death, myocardial infarction, and stroke. And we monitored other events those were non-cardiovascular deaths, bleeding complications, revascularizations, and emergent CABG. Results: There was no overall significant difference in primary endpoint between hospitals with and without onsite cardiac surgery (9.6%vs9.5%; P=0.737). There was also no significant difference when events in primary endpoint were considered separately. In other events, only revascularization was more frequently seen in hospitals with onsite cardiac surgery (22.1%vs12.9%; P<0.001). Kaplan-Meier analysis for primary endpoint showed that there was no significant difference between two groups (Log Rank P=0.943). By cox proportional hazards model analysis for primary endpoint, without onsite cardiac surgery was not a predictive factor for primary endpoint (HR 0.969, 95%CI 0.704-1.333; P=0.845). We performed propensity score matching analysis to correct for the disparate patient numbers between two groups, and there was also no significant difference for primary endpoint (6.9% vs 8.0%; P=0.544). Conclusions: There is no significant difference in clinical outcomes following PCI for ACS between hospitals with and without onsite cardiac surgery backup in Japan.

Download Full-text

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

Download Full-text

Ultrafiltration in Pediatric Cardiac Surgery Review

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/2150135119870176 ◽

2019 ◽

Vol 10 (6) ◽

pp. 778-788 ◽

Cited By ~ 2

Author(s):

Joel Bierer ◽

Roger Stanzel ◽

Mark Henderson ◽

Suvro Sett ◽

David Horne

Keyword(s):

Cardiac Surgery ◽

Clinical Outcomes ◽

Heart Surgery ◽

Fluid Overload ◽

Meta Analysis ◽

Open Heart Surgery ◽

Pediatric Cardiac Surgery ◽

Significant Heterogeneity ◽

Study Protocols ◽

The Impact

Introduction: The use of cardiopulmonary bypass in pediatric cardiac surgery is associated with significant inflammation, fluid overload, and end-organ dysfunction yielding morbidity and mortality. For decades, various intraoperative ultrafiltration techniques such as conventional ultrafiltration, modified ultrafiltration (MUF), zero-balance ultrafiltration (ZBUF), and combination techniques (ZBUF-MUF) have been used to mitigate these toxicities and promote improved postoperative outcomes. However, there is currently no consensus on the ultrafiltration technique or strategy that yields the most benefit for infants and children undergoing open heart surgery. Methods: A librarian-conducted PubMed literature search from 1990 to 2018 yielded 90 clinical studies or publications on the various forms of ultrafiltration and the impact on physiologic markers and clinical outcomes. All publications were reviewed, summarized, and conclusions synthesized. The data sets were not combined for systematic or meta-analysis due to significant heterogeneity in study protocols and patient populations. Results: Modified ultrafiltration significantly promotes improved myocardial function, reduction in fluid overload, and reduced bleeding and transfusion complications. Furthermore, ZBUF has shown a consistent reduction in inflammatory cytokines and improved pulmonary function and compliance. There is conflicting evidence that MUF, ZBUF, and ZBUF-MUF culminate in reduced ventilation time and intensive care unit stay. Conclusion: Various modes of ultrafiltration have been shown to be associated with improved physiologic function or clinical outcomes in pediatric cardiac surgery. There are some inconsistent trial results that can be explained by heterogeneity in ultrafiltration, clinical staff preferences, and institution protocols. Ultrafiltration has some essential benefit as it is ubiquitously used at pediatric heart centers; however, the optimal protocol could be yet identified.

Download Full-text

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

Download Full-text

Whole Blood del Nido versus Cold Blood Microplegia in Adult Cardiac Surgery: A Propensity-Matched Analysis

International Journal of Angiology ◽

10.1055/s-0039-3400747 ◽

2019 ◽

Author(s):

Taylor M. James ◽

Sotiris C. Stamou ◽

Cristiano Faber ◽

Marcos A. Nores

Keyword(s):

Cardiac Surgery ◽

Clinical Outcomes ◽

Whole Blood ◽

Operative Mortality ◽

Control Group ◽

Actuarial Survival ◽

Intra Aortic Balloon Pump ◽

Cold Blood ◽

Chi Square Analysis ◽

Adult Cardiac Surgery

Abstract Objectives Few studies have evaluated the outcomes of whole blood microplegia in adult cardiac surgery. Our novel protocol includes removing the crystalloid portion and using the Quest Myocardial Protection System (MPS) for the delivery of del Nido additives in whole blood. This study sought to compare early and late clinical outcomes of whole blood del Nido microplegia (BDN) versus cold blood cardioplegia (CBC) following adult cardiac surgery. Methods A total of 361 patients who underwent cardiac surgery using BDN were compared with a contemporaneous control group of 934 patients receiving CBC. Propensity matching yielded 289 BDN and 289 CBC patients. Chi-square analysis and Fisher's exact test were performed to compare preoperative, operative, and postoperative characteristics on the matched data. Primary outcome was operative mortality, and secondary outcomes included clinical outcomes such as stroke, cardiac arrest, and intra-aortic balloon pump use. The Kaplan–Meier method was used to compare actuarial survival between the two groups using a log-rank test. Results After matching, preoperative characteristics and surgery type were similar between groups. Cardioplegia type did not affect the primary end point of operative mortality. The rate of postoperative intra-aortic balloon pump was lower in BDN patients compared with CBC patients (0 vs. 2%; p = 0.01). There was no difference in late survival. Conclusions Our novel protocol BDN was comparable with CBC, with similar clinical outcomes and no difference in operative mortality or actuarial survival. Further studies should evaluate the long-term outcomes of this technique.

Download Full-text

Improved Outcomes With Integrated Intensivist Consultation for Cardiac Surgery Patients

American Journal of Medical Quality ◽

10.1177/1062860618766614 ◽

2018 ◽

Vol 33 (6) ◽

pp. 576-582 ◽

Cited By ~ 3

Author(s):

Omer W. Sultan ◽

Lori L. Boland ◽

Tyler G. Kinzy ◽

Roman R. Melamed ◽

Susan C. Seatter ◽

...

Keyword(s):

Cardiac Surgery ◽

Retrospective Cohort ◽

Care Center ◽

Risk Of Mortality ◽

Improved Outcomes ◽

Time Periods ◽

The Impact ◽

Predicted Risk ◽

Adult Cardiac Surgery ◽

Ventilator Time

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.

Download Full-text

The Effect of Different Types of Mechanical Circulatory Support on Mortality of Patients after Adult Cardiac Surgery: A Systematic Review and Meta-Analysis

The Heart Surgery Forum ◽

10.1532/hsf.2979 ◽

2020 ◽

Vol 23 (4) ◽

pp. E537-E545

Author(s):

Zhiyuan Guan ◽

Xiaoqing Guan ◽

Kaiyun Gu ◽

Yanqi Li ◽

Jin Lin ◽

...

Keyword(s):

Cardiac Surgery ◽

Clinical Outcomes ◽

Mechanical Circulatory Support ◽

Web Of Science ◽

Meta Analysis ◽

Circulatory Support ◽

Pooled Data ◽

Different Types ◽

Postcardiotomy Shock ◽

Adult Cardiac Surgery

Objectives: Sample size may limit the ability of individual studies to detect differences in clinical outcomes between extracorporeal membrane oxygenation (ECMO) alone and ECMO plus intra-aortic balloon pump (IABP) after adult cardiac surgery. Therefore, we undertook a meta-analysis of the best evidence available on the comparison of clinical outcomes of ECMO alone and ECMO plus IABP after adult cardiac surgery. Methods: PubMed, EMBASE, Web of Science, and Cochrane Center Registry of Controlled Trials were searched for studies comparing the use of ECMO alone and ECMO plus IABP after adult cardiac surgery. A meta-analysis and a sensitivity analysis were conducted. Results: Among the 472 screened articles, 24 studies (1302 cases of ECMO plus IABP and 1603 cases of ECMO) were included. A significant relationship between patient risk profile and benefits from IABP plus ECMO was found in terms of the 30-day mortality (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.62 to 0.91; P = .004) with postcardiotomy shock (PCS). However, ECMO alone was associated with lower in-hospital mortality (OR 1.75; 95% CI 1.06 to 3.01; Z = 2.19; P = .03) compared with ECMO plus IABP without PCS. Conclusions: Pooled data show that patients receiving IABP plus ECMO with PCS have lower 30-day mortality than those receiving ECMO also, which in turn show higher 30-day mortality in patients with IABP plus ECMO without PCS. Further randomized studies are warranted to corroborate these observational data.

Download Full-text