The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

2012 ◽  
Vol 15 (2) ◽  
pp. 84 ◽  
Author(s):  
Canturk Cakalagaoglu ◽  
Cengiz Koksal ◽  
Ayse Baysal ◽  
Gokhan Alici ◽  
Birol Ozkan ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Pericardial Tamponade ◽  
Anxiety Level ◽  
Control Group ◽  
Echocardiographic Study ◽  
Number Of Patients ◽  
Hospital Stays

<p><b>Aim:</b> The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).</p><p><b>Materials and Methods:</b> We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.</p><p><b>Results:</b> The 2 groups were not significantly different with respect to demographic and operative data (<i>P</i> > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (<i>P</i> < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (<i>P</i> < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (<i>P</i> = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.</p><p><b>Conclusion:</b> Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.</p>

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.

Clinical experience with a novel endotoxin adsorbtion device in patients undergoing cardiac surgery

Perfusion ◽  
2009 ◽  
Vol 24 (1) ◽  
pp. 13-17 ◽  
Author(s):  
S Blomquist ◽  
V Gustafsson ◽  
T Manolopoulos ◽  
L Pierre
Keyword(s):  
Cardiac Surgery ◽  
Platelet Count ◽  
Whole Blood ◽  
Blood Clot ◽  
Artery Bypass ◽  
Ease Of Use ◽  
Control Group ◽  
Valvular Surgery ◽  
Number Of Patients ◽  
Flow Through

Endotoxaemia is thought to occur in cardiac surgery using extracorporeal circulation (ECC) and a positive correlation has been proposed between the magnitude of endotoxaemia and risk for postoperative complications. We studied the effects of a new endotoxin adsorber device (Alteco® LPS adsorber) in patients undergoing cardiac surgery with ECC, with special reference to safety and ease of use. Fifteen patients undergoing coronary artery bypass and/or valvular surgery were studied. In 9 patients, the LPS Adsorber was included in the bypass circuit between the arterial filter and the venous reservoir. Flow through the adsorber was started when the aorta was clamped and stopped at the end of perfusion. Flow rate was kept at 150 ml/min. Six patients served as controls with no adsorber in the circuit. Samples were taken for analysis of endotoxin, TNFα, IL-1ß and IL-6 as well as complement factors C3, C4 and C1q. Whole blood coagulation status was evaluated using thromboelastograpy (TEG) and platelet count. No adverse events were encountered when the adsorber was used in the circuit. Blood flow through the device was easily monitored and kept at the desired level. Platelet count decreased in both groups during surgery. TEG data revealed a decrease in whole blood clot strength in the control group while it was preserved in the adsorber group. Endotoxin was detected in only 2 patients and IL-1ß in 4 patients. IL-6 decreased in both groups whereas no change in TNF concentrations was found. C3 fell in both groups, but no changes wer found in C4 and C1q. The Alteco® LPS adsorber can be used safely and is easy to handle in the bypass circuit. No complications related to the use of the adsorber were noted. The intended effects of the adsorber, i.e. removal of endotoxin from the blood stream could not be evaluated in this study, presumably due to the small number of patients and the relatively short perfusion times.

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

2016 ◽  
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.

scholarly journals Use of Cycle Ergometer in Early Mobilization After Cardiac Surgery: Randomized Comparative Study of Cycle Ergometer versus Habitual Treatment

2020 ◽  
Vol 4 (1) ◽  
pp. 3-13
Author(s):  
Patrícia Alcântara Vianna ◽  
Gleide Glícia Lordello ◽  
Gabriela Lago Rosier ◽  
Marcela Araújo Moura ◽  
Larissa Santana Correia ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Walking Speed ◽  
Functional Performance ◽  
Artery Bypass ◽  
Early Mobilization ◽  
Cycle Ergometer ◽  
Controlled Study ◽  
Control Group ◽  
Usual Treatment

The cycle ergometer has been proposed during the early mobilization of critically ill patients to improve muscle strength and reduce the length of stay. Although this strategy consists of greater complexity, there is no evidence that it is superior to the usual treatment. This study aims to explore the hypothesis that the use of a cycle ergometer, during early mobilization, increases functional performance after cardiac surgery, compared to active exercise. This is a randomized-controlled study that included patients undergoing valve heart surgery or coronary artery bypass grafting from June to December 2016. Patients initiate the exercise with cycle ergometer or received the usual treatment (assisted active exercise) on the first day after surgery. Both interventions were performed twice a day, without imposing a load, and a mean duration of 15 minutes, while the patients remained in the intensive care unit (ICU). The primary outcome was defined as walking speed, assessed after discharge from the ICU, measured by a blind evaluator for the patient’s allocation group. Considering this was an exploratory and preliminary study, we opted for protocol analysis, excluding patients who did not complete the exercises as a way to optimize the potential generation of hypothesis for efficacy. One hundred and eighty-seven patients completed all phases os the study (intervention and evaluation), in a total of 85 in the cycle ergometer group (CyG), and 102 in the control group (CG). In the cycle ergometer group, 18 patients had the intervention discontinued against 6 in the control group. There was no difference in the number of sessions between the groups (2.8±1.9 in CyG vs 3.2±1.5 p= 0.25). According to the BORG scale, the cycle ergometer generated a greater perception of effort (9.9±2.7 vs 8.21±1.8; p = 0.009) and promoted a better increase in respiratory rate (3.2±4.5 vs 0.3±6.1 ipm, p = 0.02). However, the walking speed did not differ between groups (0.44 ± 0.23 vs 0.47 ± 0.21 m/s; p= 0.34). Despite imposing a higher level effort, the use of cycle ergometer during the early mobilization in the ICU does not promote an increase in functional capacity when compared to active assisted exercise in patients’ underground cardiac surgery.   O cicloergômetro vem sendo proposto durante a mobilização precoce de pacientes críticos a fim de melhorar força muscular e reduzir tempo de internamento. Embora essa estratégia consista em maior complexidade, não existe comprovação de que esta seja superior ao tratamento usual. O objetivo deste estudo foi o de explorar a hipótese de que a utilização de cicloergômetro, durante a mobilização precoce, incrementa o desempenho funcional após cirurgia cardíaca, comparado ao exercício ativo. Este foi um estudo controlado, envolvendo pacientes submetidos a cirurgia cardíaca valvar e/ou revascularização miocárdica no período de junho a dezembro de 2016. Os pacientes foram randomizados, no primeiro dia após a cirurgia, para exercícios com cicloergômetro ou tratamento usual (exercício ativo assistido). Ambas as intervenções foram realizadas duas vezes ao dia, sem imposição de carga, com duração média de 15 minutos, enquanto os pacientes permaneciam na unidade de terapia intensiva (UTI). O desfecho primário foi definido como velocidade de marcha, avaliada após a alta da UTI, mensurada por um avaliador cego para o grupo de alocação do paciente. Em se considerando este um estudo exploratório e preliminar, como forma de otimizar a potencial geração de hipótese para eficácia, optou-se pela análise por protocolo, excluindo os pacientes que não completaram os exercícios. Cento e oitenta e sete pacientes concluíram todas as etapas de intervenção e avaliação, totalizando 85 no grupo cicloergômetro (GCi) e 102 no grupo controle (GC). No grupo cicloergômetro, 18 pacientes tiveram a intervenção descontinuada contra 6 do grupo controle. Não houve diferença no número sessões entre os grupos (2,8±1,9 no GCi vs 3,2±1,5 p= 0,25). De acordo com escala de BORG, o cicloergômetro gerou maior percepção de esforço (9,9±2,7 vs 8,21±1,8; p = 0,009) e promoveu maior elevação da frequência respiratória (3,2±4,5 vs 0,3±6,1 ipm, p = 0,02). No entanto, a velocidade de marcha não apresentou diferença entre os grupos (0,44 ± 0,23 vs 0,47 ± 0,21 m/s; p = 0,34). A despeito de impor maior nível de esforço, a utilização de cicloergômetro durante a mobilização precoce em UTI não promove incremento de capacidade funcional quando comparado ao exercício ativo assistido livre em pacientes submetidos à cirurgia cardíaca.cardiac surgery.

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

2015 ◽  
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.

scholarly journals Effect of Alpha-Lipoic Acid on Atrial Fibrillation after Open Heart Surgery

2020 ◽  
Author(s):  
Wael Elfeky ◽  
Dalia R El-Afify
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Lipoic Acid ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Group Versus ◽  
Control Group ◽  
Alpha Lipoic Acid ◽  
Reactive Protein

Background: Postoperative atrial fibrillation (POAF) is associated with increased morbidity and mortality, and an inflammatory process is involved in its pathogenesis. We aimed to study the possible effect of alpha-lipoic acid (ALA) as an antioxidant on atrial fibrillation after cardiac surgery. Methods: The study included ninety patients who underwent cardiac surgery, either valvular or coronary artery bypass grafting using cardiopulmonary bypass, and were randomized into two groups: Control and ALA groups. Blood samples were obtained to measure preoperative and postoperative levels of malondialdehyde (MDA), glutathione, C-reactive protein (CRP) and interleukin-6 (IL-6). The patients were monitored for the occurrence of atrial fibrillation until the day of discharge. Results: POAF occurred in 33% in the control group versus 11% in the ALA group (p=0.011).  When compared to the control group, ALA significantly decreased the postoperative levels of MDA (4.78±0.91 vs. 5.36±1.03 nmol/ml; p= 0.006) CRP (19.44±3.14 vs. 26.56±6.29 mg/dl; p <0.001) and IL-6 (22.25±2.2 vs. 25.37±2.5 pg/ml; p< 0.001) while glutathione level increased significantly in patients who received ALA (26.4±4.59 vs. 23.44±5.11 mg/l; p= 0.005). Conclusion: ALA may help in the prevention of atrial fibrillation following cardiac surgery through exerting antioxidant and anti-inflammatory effects.

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

2018 ◽  
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.

scholarly journals Prognosis After the Implantation of an Intra-Aortic Balloon Pump in Cardiac Surgery Calculated With a New Score

Circulation ◽  
2002 ◽  
Vol 106 (12_suppl_1) ◽  
Author(s):  
Harald Hausmann ◽  
Evgenij V. Potapov ◽  
Andreas Koster ◽  
Thomas Krabatsch ◽  
Julia Stein ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Control Group ◽  
Ventricular Assist ◽  
Intra Aortic Balloon Pump ◽  
Mixed Venous Saturation ◽  
Poor Outcomes ◽  
Postcardiotomy Cardiogenic Shock

Background Over the past decade, the use of a ventricular-assist device (VAD) in patients with postcardiotomy cardiogenic shock has resulted in hospital discharge rates of 25% to 40% and is improving. Nevertheless, indications for and timing of the implantation of a VAD in patients who have received an intra-aortic balloon pump (IABP) remain unclear. Methods and Results From July 1996 to March 2000, 391 patients with cardiac low-output syndrome who underwent open-heart surgery and had an IABP implanted were analyzed in a retrospective pilot study. The perioperative mortality was 34% (133 patients). Clinical parameters were analyzed 1 hour after IABP support began. Statistical multivariate analysis showed that patients with an adrenaline requirement higher than 0.5 μg · kg −1 · min −1 , a left atrial pressure >15 mm Hg, urine output <100 mL/h, and mixed venous saturation (S v O 2 ) <60% had poor outcomes. Using this data, we developed an IABP score (0 to 5 points) to predict survival early after IABP implantation in cardiac surgery. We evaluated our score by monitoring another 101 patients as a control group prospectively. Additionally, 210 patients who received coronary artery bypass grafting (CABG) exclusively were analyzed. All investigations confirmed the validity of the score. Conclusions The IABP score can predict survival early after IABP implantation. In patients with a high IABP score, implantation of a VAD should be considered.

scholarly journals The Role of Statins in the Management of Patients Undergoing Coronary Artery Bypass Grafting

Diseases ◽  
2018 ◽  
Vol 6 (4) ◽  
pp. 102
Author(s):  
Dimitrios Siskos ◽  
Konstantinos Tziomalos
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Preoperative Administration ◽  
Number Of Patients ◽  
High Doses

Each year, a large number of patients undergo coronary artery bypass grafting surgery (CABG) worldwide. Accumulating evidence suggests that the preoperative administration of statins might be useful in preventing adverse events after CABG. In the present review, we discuss the role of statins in the perioperative management of patients undergoing CABG. Preoperative administration of statins in these patients substantially reduces the risk of postoperative atrial fibrillation and shortens hospital and intensive care unit (ICU) stay. Atorvastatin appears to be more effective, particularly when administered at high doses. Given these benefits and the safety of statins, their administration should be considered in patients undergoing CABG, even though the statins do not appear to affect the incidence of cardiovascular events and overall mortality perioperatively.

scholarly journals The Impact of Perioperative Viscoelastic Test Application on Blood Product Usage and Outcome in Cardiac Surgery; Regional Cardiac Surgery Center Experience

2021 ◽  
Author(s):  
Murat Aksun ◽  
Saliha Aksun ◽  
Mehmet Ali Çoşar ◽  
Elif Neziroğlu ◽  
Senem Girgin ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Experience ◽  
Heart Surgery ◽  
Blood Product ◽  
Open Heart Surgery ◽  
Control Group ◽  
Open Heart ◽  
Blood Products ◽  
Product Use ◽  
The Impact

Objective: Thromboelastography (TEG) is a diagnostic modality that gives information about coagulation. Despite all blood-preserving precautions in open heart surgery there are blood losses and the use of blood and blood products becomes inevitable. TEG is mostly not available in every center and habits, trends and clinical experience in blood use create the possibility of causing unnecessary use of blood and blood products. In this study, it was aimed to determine the effect of the use of thromboelastography on the use of blood and blood products in cardiac surgery. Methods: Two hundred patients between 18-70 years old who underwent open heart surgery were included in the study. After the cardiopulmonary bypass (CPB), the cases were confirmed to have an Activated Clotting Time (ACT) value in the range of 120-150 sec after protamine administration. In 100 patients in the TEG group, the coagulation status was evaluated with TEG and it was decided how to apply blood and blood product use. Blood and blood product use was applied to 100 patients in the control group based on clinical experience and foresight. The total amount of blood and blood product used, fluid balance, need for inotropics, mechanical ventilator time, complications, duration of intensive care and discharge times were recorded. Results: Use of Fresh Frozen Plasma (FFP) at the after CPB in the TEG group was statistically significantly lower than that of the control group FFP (p<0.05). Postoperative FFP and postoperative platelet use in the study group were statistically significantly lower than in the postoperative FFP and postoperative platelet values of the control group (p <0.05). Conclusion: The use of thromboelastography is a very useful monitoring in terms of reducing FFP use after CPB and reducing FFP and platelet usage in the postoperative period. In this way, the unnecessary use of blood and blood products can be prevented.

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