A Reproducible and Effective Technique for Coronary Sinus Injury Repair

2022 ◽  
pp. 155698452110603
Author(s):  
Shane P. Smith ◽  
Charlotte R. Spear ◽  
Patrick E. Ryan ◽  
David M. Stout ◽  
Samuel J. Youssef ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Coronary Sinus ◽  
Operative Time ◽  
Artery Bypass ◽  
Effective Technique ◽  
Intraoperative Complication ◽  
Perioperative Morbidity ◽  
Retrograde Cardioplegia ◽  
Perioperative Bleeding ◽  
Life Threatening

Objective: Coronary sinus injury related to the use of a retrograde cardioplegia catheter is a rare but potentially life-threatening complication with mortality reported as high as 20%. We present a series of iatrogenic coronary sinus injuries as well as an effective method of repair without any ensuing mortality. Methods: There were 3,004 cases that utilized retrograde cardioplegia at our institution from 2007 to 2018. Of these, 15 patients suffered a coronary sinus injury, an incidence of 0.49%. A pericardial roof repair was performed in 14 cases in which autologous pericardium was sutured circumferentially to normal epicardium around the injury with purified bovine serum albumin and glutaraldehyde injected into the newly created space as a sealant. Incidence of perioperative morbidity and mortality, operative time, and length of stay were collected. Results: In our series, there were no intraoperative or perioperative mortalities. Procedure types included coronary artery bypass grafting (CABG), valve replacement and repair, or combined CABG and valve procedures. Median (interquartile range) cross-clamp time was 100 (88 to 131) minutes, cardiopulmonary bypass duration was 133 (114 to 176) minutes, and length of stay was 6 (4 to 8) days. None of the patients returned to the operating room for hemorrhage, and there were no complications associated with the repair of a coronary sinus injury when using the pericardial roof technique. Conclusions: Coronary sinus injuries can result in difficult to manage perioperative bleeding and potentially lethal consequences from cardiac manipulation. Our series supports the pericardial roof technique as an effective solution to a challenging intraoperative complication.

scholarly journals Factors Predicting Coronary Sinus Rupture following Cannula Insertion for Retrograde Cardioplegia

2011 ◽  
Vol 6 ◽  
pp. CMC.S7861 ◽  
Author(s):  
Feridoun Sabzi ◽  
Abdolhamid Zokaei
Keyword(s):  
Body Mass Index ◽  
Regression Analysis ◽  
Multiple Regression Analysis ◽  
Multiple Regression ◽  
Body Mass ◽  
Coronary Sinus ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Retrograde Cardioplegia ◽  
Inexperienced Surgeon

Background Coronary sinus rupture (CSR) is a rare preventable complication of cannula insertion for retrograde cardioplegia. In the hands of an inexperienced surgeon, this complication has the risk of potential mortality and morbidity, and its repair is technically challenging. Techniques for repairing CSR have been reported previously. In this study, we determined predictors of CSR following coronary artery bypass graft (CABG) surgery. Methods Over a four-year period, we retrospectively analyzed 1500 patients in whom a retrograde coronary sinus catheter was used to administer cardioplegic solution. CSR occurred in 15 patients. (12 women and 3 men). Variables such as age, weight, body mass index, gender, aortic clamp time, pump time, cardiomegaly, ejection fraction, and number of grafts were determined for each patient. Factors correlated with CSR were analyzed using multiple regression analysis, and odd ratios of significant variables were determined. Results In multiple regression analysis, factors such as female gender, age, weight, and body mass index showed a significant correlation with CSR, and their odd ratios were 4.2, 1.0, 0.96, and 2.2, respectively. Conclusion In all 15 cases, a retrograde cannula with a self-inflatable balloon was used and 12 patients were woman with low body mass index. Forceful insertion due to coronary sinus web, fragility of arteries in thin patients, or a small coronary sinus caused CSR in the hands of an inexperienced surgeon.

REEVALUATION OF THE DIAGNOSIS RELATED GROUPS SYSTEM IN GREECE: THE EXAMPLE OF CORONARY ARTERY BYPASS GRAFT PROCEDURE

2016 ◽  
Vol 10 (3) ◽  
pp. 2163-2167
Author(s):  
Georgios Tagarakis ◽  
Costas Dikeos ◽  
Nikolaos Tsilimingas ◽  
Nikolaos Polyzos
Keyword(s):  
Renal Failure ◽  
Coronary Artery ◽  
Length Of Stay ◽  
Coronary Artery Bypass Graft ◽  
Coronary Artery Bypass ◽  
Myocardial Infarct ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Artery Bypass Graft ◽  
Perioperative Bleeding

Background. Aim of the current prospective study is to investigate and revise the basic information related to the coronary artery bypass graft (CABG) procedure, in an attempt to reevaluate the current Greek Diagnosis Related Groups (DRGs) system. Methods. In a Greek academic cardiothoracic surgical department, implementing clinical therapeutic protocols, we prospectively recruited 75 patients planned to undergo elective CABG. All basic demographic, medical and perioperative data were gathered in an extensive database, so asto be compared with data predicted by the DRG’s system. Clinical indicators of performance aiming towards quality control were: perioperative mortality, postoperative myocardial infarct, postoperative stroke, postoperative renal failure, total hospital length of stay, rate of reoperation and rate of readmission. Results. None of the study patients deceased. No cases of perioperative myocardial infarct, stroke or renal failure were observed. Two of the patients developed respiratory failure, and one was reoperated for the control of perioperative bleeding. There were no cases of readmission to the hospital. The total length of stay was longer than the DRG’s prediction (mean 11.5 vs 7 days), owed partially to the preoperative stay (mean 3.18days) in the department, due to reasons of medical vigilance and organisatory problems that led to the postponement of the operation. Conclusions. A review of the CABG related DRG’s in Greece seems appropriate, based on the findings of the current study, suggesting a longer than predicted hospital stay.

Coronary sinus rupture with retrograde cardioplegia

Perfusion ◽  
2002 ◽  
Vol 17 (1) ◽  
pp. 77-80 ◽  
Author(s):  
Mark Kurusz ◽  
Mark K Girouard ◽  
Paul S Brown
Keyword(s):  
Coronary Sinus ◽  
Coronary Artery Bypass Surgery ◽  
Primary Repair ◽  
Rare Complication ◽  
Artery Bypass ◽  
Aortic Insufficiency ◽  
Anterior Wall ◽  
Left Ventricular ◽  
Pericardial Patch ◽  
Retrograde Cardioplegia

Coronary sinus (CS) rupture occurring during retrograde cardioplegia (RCP) is a rare complication. Patients with left ventricular hypertrophy are at higher risk for injury to the CS. The patient was a 66-year-old female with hypertension, ischemic cardiomyopathy and dysrhythmias, who had evidence of an anterior wall myocardial infarction, congestive heart failure and angina. During coronary artery bypass surgery, antegrade cardioplegia was initially administered, but aortic insufficiency prevented adequate myocardial cooling. RCP was then administered and the heart cooled appropriately. After approximately 300 ml of blood cardioplegic solution had been given, the CS pressure suddenly dropped from 30 mmHg to zero. RCP administration was stopped, and the surgeon palpated a hematoma over the area of the CS, which later ruptured upon rotation of the heart. A primary repair could not be performed, so a pericardial patch was placed over the area of disruption, which appeared to provide adequate hemostasis. The patient was weaned from cardiopulmonary bypass (CPB), but began to bleed freely from the CS distal to the pericardial patch. The patient was placed back on CPB to allow further repair of the CS, but the tissues were thin and friable and the ventricle disassociated from the ventricular septum. The situation was deemed not salvageable and further attempts at repair were stopped. The perfusionist should monitor infusion pressures and the CS waveform during RCP delivery. Changes in the waveform may indicate cannula malposition, loss of balloon seal, or, more rarely, CS rupture; such changes should prompt immediate cessation of RCP delivery.

Effect of operative time on complications following primary total hip arthroplasty: analysis of the NSQIP database

2020 ◽  
pp. 112070002094970
Author(s):  
Mark Sikov ◽  
Matthew Sloan ◽  
Neil P Sheth
Keyword(s):  
Total Hip Arthroplasty ◽  
Length Of Stay ◽  
Hip Arthroplasty ◽  
Operative Time ◽  
Complication Rates ◽  
Improvement Program ◽  
Perioperative Morbidity ◽  
Total Hip ◽  
Risk Of Death ◽  
Increased Risk

Background: Long operative times in total hip arthroplasty (THA) have been shown to be associated with increased risk of revision as well as perioperative morbidity. This study assesses the effect of extended operative times on complication rates following primary THA using the most recent national data. Methods: The National Surgical Quality Improvement Program (NSQIP) database (2008–2016) was queried for primary THA. Groups were defined by operative time 1 standard deviation (1 SD) above the mean. Univariate, propensity score-matched, and multivariate logistic regression analyses were performed to evaluate outcomes. Results: Data was available for 135,013 THA patients. Among these groups, mean operative time in the extended operative time group was 166 minutes (compared with 82 minutes). Patients undergoing longer operative times were 3.8 years younger, had a 1.5 kg/m2 higher body mass index and had a 0.5 day longer mean length of stay. Propensity matching identified 16,123 pairs for analysis in the 1 SD group. Longer operative time led to 173% increased risk of major medical morbidity, 140% increased likelihood of length of stay greater than 5 days, 59% increased risk of reoperation, 45% increased risk of readmission, and a 30% decreased likelihood of return to home postoperatively. There was no increased risk of death within 30 days. Conclusion: Long operative times were associated with increases in multiple postoperative complications, but not mortality. Surgeons should be advised to take steps to minimise operative time by adequate preoperative planning and optimal team communication.

Effect of Undertriage on the Outcomes of Cancer Patients with Febrile Neutropenia, Sepsis, and Septic Shock

2021 ◽  
pp. 105477382199968
Author(s):  
Anas Alsharawneh
Keyword(s):  
Emergency Department ◽  
Septic Shock ◽  
Length Of Stay ◽  
Febrile Neutropenia ◽  
Cancer Patients ◽  
Emergency Setting ◽  
Extended Length ◽  
Life Threatening ◽  
Sepsis And Septic Shock ◽  
Timely Treatment

Sepsis and neutropenia are considered the primary life-threatening complications of cancer treatment and are the leading cause of hospitalization and death. The objective was to study whether patients with neutropenia, sepsis, and septic shock were identified appropriately at triage and receive timely treatment within the emergency setting. Also, we investigated the effect of undertriage on key treatment outcomes. We conducted a retrospective analysis of all accessible records of admitted adult cancer patients with febrile neutropenia, sepsis, and septic shock. Our results identified that the majority of patients were inappropriately triaged to less urgent triage categories. Patients’ undertriage significantly prolonged multiple emergency timeliness indicators and extended length of stay within the emergency department and hospital. These effects suggest that triage implementation must be objective, consistent, and accurate because of the several influences of the assigned triage scoring on treatment and health outcomes.

scholarly journals Application of ultrasound-guided intranodal lymphangiography and embolisation in cancer patients with postoperative lymphatic leakage

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xingwei Sun ◽  
Feng Zhou ◽  
Xuming Bai ◽  
Qiang Yuan ◽  
Mingqing Zhang ◽  
...  
Keyword(s):  
Cancer Patients ◽  
Operative Time ◽  
Length Of Hospital Stay ◽  
Chylous Ascites ◽  
Pelvic Surgery ◽  
Ultrasound Guided ◽  
Technical Success Rate ◽  
Life Threatening ◽  
Low Incidence ◽  
Intranodal Lymphangiography

Abstract Background Traumatic lymphatic leakage is a rare but potentially life-threatening complication. The purpose of this study was to introduce ultrasound-guided intranodal lymphangiography and embolisation techniques for postoperative lymphatic leakage in patients with cancer. Methods From January 2018 through June 2020, seven cancer patients (three males, four females, aged 59–75 years [mean 67.57 ± 6.11 years]) developed lymphatic leakage after abdominal or pelvic surgery, with drainage volumes ranging from 550 to 1200 mL per day. The procedure and follow-up of ultrasound-guided intranodal lymphangiography and embolisation were recorded. This study retrospectively analysed the technical success rate, operative time, length of hospital stay, clinical efficacy, and complications. Results The operation was technically successful in all patients. Angiography revealed leakage, and embolisation was performed in all seven patients (7/7, 100%). The operative time of angiography and embolisation was 41 to 68 min, with an average time of 53.29 ± 10.27 min. The mean length of stay was 3.51 ± 1.13 days. Lymph node embolisation was clinically successful in five patients (5/7, 71.43%), who had a significant reduction in or disappearance of chylous ascites. The other two patients received surgical treatment 2 weeks later due to poor results after embolisation. All patients were followed for 2 weeks. No serious complications or only minor complications were found in all the patients. Conclusions Ultrasound-guided intranodal lymphangiography and embolisation were well tolerated by the patients, who experienced a low incidence of complications. Early intervention is recommended for cancer patients with postoperative lymphatic leakage.

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

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