scholarly journals Effective Telehealth – Open Heart Readmissions

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Varun Rao ◽  
Michael GeRue ◽  
Douglas Gray
Keyword(s):  
Heart Surgery ◽  
Demographic Data ◽  
Hospital Readmissions ◽  
Open Heart Surgery ◽  
Retrospective Chart Review ◽  
Office Visit ◽  
Wound Complications ◽  
Open Heart ◽  
Office Visits ◽  
Significant Difference

Background  The purpose of this study is to compare open heart surgery (OHS) Telehealth patients (TP) and non-Telehealth patients (NTP) using outcomes data such as hospital readmission, emergency department (ED) presentations, observation hours, and office visits. Visits for atrial fibrillation (Afib), pleural effusions (PE), and sternal wound complications (SWC) are of particular interest for this study.      Methods  A retrospective chart review of 110 patients above 18 years old who had OHS at Parkview Heart Institute from 2020 were assessed using hospital readmissions, ED presentations, observation hours, and office visits outcomes. Separate forms for blinding, demographic data, and surgery information were completed for every patient. A Telehealth form was completed out for every Telehealth intervention had per TP. An outcomes form was completed for each outcome had by each patient. TP outcomes were compared with NTP outcomes. Fisher’s exact test and X2 was used for statistical analysis (p=0.05).    Results  Results display a sample size of the total patient population (110/436). There was no significant difference found between NTP and TP in terms of office visits (79.5% vs 93%, p=0.598), readmissions (3 vs 6, p=0.889), and observation visits (0 vs 3, p=0.558). Significance was found between NTP and TP in terms of ED visits (0 vs 9, p=0.025). Most frequent reason for NTP readmission “other” (7.7%) and TP “other” (4.2%), reason for ED visit for NTP (all 0%) and TP “other” (7.0%), reason for observation visit for NTP (all 0%) and TP “other” (1.4%), reason for office visit for NTP “other” (76.9%) and TP “other” (91.5%).     Conclusion  TP presented to the ED significantly more than NTP. The largest outcome category was “surgery follow up” office visits listed in the “other” section. Data collection and analysis are in progress. At the time of writing this abstract, final results are not yet available. 

P1836Constrictive pericarditis after open heart surgery: a 20-year case controlled study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A E Moreyra ◽  
Y Yang ◽  
S Zinonos ◽  
N M Cosgrove ◽  
J Cabrera ◽  
...  
Keyword(s):  
Constrictive Pericarditis ◽  
Heart Surgery ◽  
Rare Complication ◽  
Open Heart Surgery ◽  
Controlled Study ◽  
Robert Wood Johnson Foundation ◽  
Open Heart ◽  
Significant Difference ◽  
Long Term Prognosis

Abstract Background Constrictive pericarditis (CoPe) after open-heart surgery (OHS) is a rare complication. Information on the incidence, determinants, and prognosis of this condition has been scarcely reported. Purpose To investigate the long term prognosis of CoPe after OHS. Methods Using the Myocardial Infarction Data Acquisition System database, we analyzed records of 144,902 patients that had OHS in New Jersey hospitals between 1995 and 2015. CoPe was identified in 79 patients after discharge. Differences in proportions were analyzed using chi square. Cases and controls were matched for demographics and comorbidities. Cox proportional hazard models were used to evaluate outcome risks. Log-rank test was used to assess differences in the Kaplan-Meier survival curves. Results Patients with CoPe were more likely to have history of valve disease (HVD) (p<0.0001), atrial fibrillation (AF) (p=0.0006) and chronic kidney disease (CKD) (p=0.012). Significant predictors of CoPe were AF (HR 1.62, 95% CI 1.02–2.59), CKD (HR 2.70, 95% CI 1.53–4.76), diabetes (HR 1.73, 95% CI 1.08–2.80) and HVD (HR 3.11, 95% CI 1.88–5.15). Patients with CoPe compared to matched controls had a higher 10-year mortality (p<0.0001). This became a statistically significant difference at 6 years after surgery (Figure). Survival Curve Conclusion Constrictive pericarditis is a rare complication of OHS and occurs more frequently in patients with AF, CKD, diabetes and HVD. It is associated with an unfavorable long-term prognosis. The data highlight the need for strategies to help prevent this complication. Acknowledgement/Funding Robert Wood Johnson Foundation

scholarly journals Case report of simultaneous transcatheter mitral valve-in-valve implantation and percutaneous closure of two paravalvular leaks

2019 ◽  
Vol 3 (3) ◽  
Author(s):  
Masahiko Asami ◽  
Thomas Pilgrim ◽  
Stephan Windecker ◽  
Fabien Praz
Keyword(s):  
Mitral Valve ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Transoesophageal Echocardiography ◽  
Paravalvular Leak ◽  
Open Heart ◽  
Surgical Risk ◽  
Significant Difference ◽  
Valve In Valve ◽  
Valve Implantation

Abstract Background Concomitant structural degeneration of surgical mitral bioprostheses and paravalvular leak (PVL) is rare but potentially fatal. Data pertaining to simultaneous transcatheter mitral valve implantation (TMVI) and percutaneous PVL closure are limited, and the optimal treatment strategy remains undetermined. We report a case of simultaneous TMVI and double percutaneous PVL closure in a patient with a degenerated bioprosthetic mitral valve and associated medial and lateral PVLs. Case summary A 75-year-old woman who underwent combined aortic (Edwards Perimount Magna 19 mm) and mitral (Edwards Perimount Magna 25 mm) surgical valve replacement 6 years ago was referred for treatment of new-onset orthopnoea and severely reduced exercise capacity. Transoesophageal echocardiography revealed severe mitral stenosis and concomitant moderate to severe mitral regurgitation, originating from two PVLs located medial and lateral from the surgical bioprosthesis. Due to high surgical risk, we performed successful transseptal mitral valve-in-valve (ViV) implantation combined with the closure of two PVLs during the same procedure. Discussion Although surgery should be considered as a first-line treatment in this setting, most patients have extremely high or prohibitive surgical risk inherent to repeat open heart surgery. Mitral ViV implantation appears a reasonable treatment option for patients with failed mitral bioprostheses. Furthermore, a recent study of percutaneous PVL closure showed no significant difference in long-term all-cause mortality compared with redo open-heart surgery. Simultaneous TMVI and percutaneous PVL closure appears feasible in selected high-risk patients.

scholarly journals The Effect of Distraction with a Loved One’s Voice on Pain Reduction While Extracting the Chest Tube after Open Heart Surgery

2019 ◽  
Vol 12 (1) ◽  
pp. 6-10
Author(s):  
Hakimeh Sheykhasadi ◽  
Abbas Abbaszadeh ◽  
Homira Bonakdar ◽  
Fatemeh Salmani ◽  
Asghar Tavan ◽  
...  
Keyword(s):  
Chest Tube ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Control Group ◽  
Open Heart ◽  
Care Providers ◽  
Tube Removal ◽  
Significant Difference ◽  
Chest Tube Removal ◽  
The Impact

Background:One of the forms of ost-operative care after open heart surgery is controlling the pain resulting from chest tube insertion. Management of pain is considered vital and requires the awareness of health care providers. One of the main responsibilities of nurses is to prepare patients for invasive procedures such as the removal of the chest tube. This study was designed to analyze the impact of a loved one’s voice for distraction in patients undergoing open heart surgery.Methods:This study was a clinical trial. The research sample was randomly selected from patients undergoing open heart surgery. In this study, the number of samples for each group was considered to be 64 people, where the total number of samples was 128 people. The data collection tools included Visual Analog Scale (VAS) assessment tool and a researcher-made questionnaire. After selecting the eligible samples and obtaining the informed consent, each patient was randomly assigned to one of the two groups (intervention group and control group). The pain was measured before, immediately, and 10 minutes after removing the chest tube.Results:The findings of this study indicated that the two groups had no statistically significant differences in pain before chest tube removal. The mean pain during chest tube removal and 10 minutes later in both groups indicated a significant difference based on Mann-Whitney test (P<0.001).Conclusion:This study showed that a loved one’s voice is effective in reducing pain during chest tube removal after open heart surgery.

scholarly journals Open Cardiac Surgery without Blood and Blood Products Transplantation

2017 ◽  
Vol 20 (6) ◽  
pp. 239 ◽  
Author(s):  
Mehmet Kaplan ◽  
Tolga Can ◽  
Anil Karaagac ◽  
Murat Acarel ◽  
Adlan Olsun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Urine Output ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Morbidity And Mortality ◽  
Open Heart ◽  
Blood Products ◽  
Mortality And Morbidity ◽  
Significant Difference

Background: Blood transfusions are the most common type of tissue and organ transplantation. Perioperative and postoperative transfusions may cause morbidity and mortality and transfusion should based on only hematocrit values but also on hemodynamic and clinical parameters of the patient, which cannot be ignored.Methods: A prospective study was conducted between January 2015 and October 2016 with adult patients undergoing elective open heart surgery. In these patients, a protocol was established, and patients were divided into two groups as transfusion (-) and transfusion (+). In the first 24 hours in the intensive care unit, patients’ drainage, 24-hours urine output, awakening and extubation times, and lactate and bilirubin levels in arterial blood gases were recorded. Thirty-day mortality and morbidity, and hemodynamic and clinical data were compared between these two groups.Results: We have performed a total of 138 cases; no blood and blood products were transfused in 71% (n = 98), and in 29.0% (n = 40) blood and blood products were transfused. Thirty-day mortality and morbidity (arrhythmia, infectious and pulmonary morbidity, myocardial infarction, cerebrovascular accident, renal dysfunction, sternal revision) were compared between these two groups and no statistically significant difference was observed. Patients’ awakening, extubation time, cardiopulmonary bypass period, cross-clamp time, and days in intensive care unit and hospital were compared, and there was no statistically significant difference between the two groups. Conclusion: In this study, we conclude that open heart surgery without blood transfusion may be accomplished with decent peri/postoperative management. The patients who did not receive any blood or blood products were not compromised clinically or hemodynamically. No extra morbidity and mortality were seen in the non-transfusion group. Transfusion decision was based on clinical and hemodynamic parameters such as persistent hypotension or tachycardia, hyperlactatemia, low urine output, and anemic symptoms. 

The value of procalcitonin in systemic inflammatory response syndrome after open-heart surgery for CHD

2019 ◽  
Vol 29 (11) ◽  
pp. 1335-1339
Author(s):  
Kuntum Basitha ◽  
Rubiana Sukardi ◽  
Ratna Farida Soenarto ◽  
Suprayitno Wardoyo
Keyword(s):  
Platelet Count ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Systemic Inflammatory Response ◽  
Open Heart ◽  
Time Duration ◽  
Procalcitonin Level ◽  
Significant Difference

AbstractBakground:Systemic inflammatory response syndrome, which is marked by fever, is a possible complication after open-heart surgery for CHD. The inflammatory response following the use of cardiopulmonary bypass shows similar clinical signs with sepsis. Therefore serial measurements of procalcitonin, an early infection marker, can be helpful to differentiate between sepsis and systemic inflammatory response syndrome.Objectives:To evaluate serial levels of procalcitonin in children who underwent open-heart surgery for cyanotic and acyanotic CHD, and identify factors associated with elevated level of procalcitonin.Methods:Children and infants who had open-heart surgery and showed fever within 6 hours after surgery were recruited. Procalcitonin levels were serially measured along with leukocyte and platelet count. Other data were also recorded, including diagnosis, age, body weight, axillary temperature, aortic clamp time, bypass time, duration of mechanical ventilation, risk adjustment for congenital heart surgery score-1, and length of stay in Cardiac ICU. The patients were categorised into cyanotic and acyanotic CHD groups.Results:High mean of procalcitonin level suggested the presence of bacterial infection. Cyanotic CHD group had significantly higher mean of procalcitonin level compared to acyanotic CHD group in the first two measurements. Both groups had no leukocytosis, though platelet count results were significantly different between the two groups. There was no significant difference of procalcitonin level observed in culture results and adverse outcomes.Conclusion:Serial procalcitonin measurement can be helpful to determine the cause of fever. Meanwhile other conventional markers such as leukocyte and platelet should be assessed thoroughly.

Neuromotor performance in infants before and after early open-heart surgery and risk factors for delayed development at 6 months of age

2018 ◽  
Vol 29 (2) ◽  
pp. 100-109 ◽  
Author(s):  
Miranda J. Campbell ◽  
Jenny M. Ziviani ◽  
Christian F. Stocker ◽  
Asaduzzaman Khan ◽  
Leanne Sakzewski
Keyword(s):  
Risk Factors ◽  
Motor Performance ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Rank Test ◽  
Open Heart ◽  
Motor Delay ◽  
Significant Difference ◽  
General Movements ◽  
Delayed Development

AbstractBackgroundEarly identification of infants with CHD at heightened risk of developmental delays can inform surveillance priorities. This study investigated pre-operative and post-operative neuromotor performance in infants undergoing open-heart surgery, and their developmental status at 6 months of age, to identify risk factors and inform care pathways.MethodsInfants undergoing open-heart surgery before 4 months of age were recruited into a prospective cohort study. Neuromotor performance was assessed pre-operatively and post-operatively using the Test of Infant Motor Performance and Prechtl’s Assessment of General Movements. Development was assessed at 6 months of age using the Ages and Stages Questionnaire third edition. Pre-operative and post-operative General Movements performance was compared using McNemar’s test and test of infant motor performance z-scores using Wilcoxon’s signed rank test. Risk factors for delayed development at 6 months were explored using logistic regression.ResultsSixty infants were included in this study. In the 23 (38%) infants. A total of 60 infants were recruited. In the 23 (38%) infants assessed pre-operatively, there was no significant difference between pre- and post-operative performance on the GMs (p=0.63) or TIMP (p=0.28). At discharge, 15 (26%) infants presented with abnormal GMs, and the median TIMP z-score was −0.93 (IQR: −1.4 to −0.69). At 6 months, 28 (52.8%) infants presented with gross motor delay on the ASQ-3, significantly negatively associated with gestational age (p=0.03), length of hospital stay (p=0.04) and discharge TIMP score (p=0.01).ConclusionsPost-operative assessment using the GMs and TIMP may be useful to identify infants requiring individualised care and targeted developmental follow-up. Long-term developmental surveillance beyond 6 months of age is recommended.

scholarly journals Postoperative nonlethal complications following open heart surgery

2012 ◽  
Vol 69 (1) ◽  
pp. 27-31
Author(s):  
Miodrag Golubovic ◽  
Bogoljub Mihajlovic ◽  
Pavle Kovacevic ◽  
Nada Cemerlic-Adjic ◽  
Katica Pavlovic ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Health Workers ◽  
Average Rate ◽  
Open Heart Surgery ◽  
Operative Risk ◽  
Risk Level ◽  
Consecutive Series ◽  
Open Heart ◽  
Significant Difference ◽  
High Degree

Background/Aim. Postoperative nonlethal complications after open heart surgery are a serious clinical problem causing a considerable engagement of health workers, an augmented use of drugs, and prolonged operation incapacity leading to prolonged hospital stay and increased expenses. The aim of the study was to establish whether there is any correlation between the level of expected operative risk and postoperative nonlethal complications. Methods. A consecutive series of 853 patients subjected to the open heart surgery were investigated, 622 (73%) males and 231 (27%) females. The average age of the patients was 57.2 ? 9.9 (16-81) years. The patients were divided into 3 groups according to the additive EuroSCORE model: groups I, II and III with the expected operative risk of 0%-2%, 2%- 5% and over 5%, respectively. The data were collected prospectively and analyzed retrospectively. Statistical methods of correlation and t-test were used. Results. A high degree of correlation between the operative risk level and frequency of postoperative nonlethal complications (R = 0.98) was found. The average rate of complications was 24% for the whole group of 853 patients. It accounted for 21%, 29% and 47% in the groups I, II and III, respectively. According to the expected operative risk level there was a statistically significant difference in respect of heart arrhythmias (p = 0.02), neurologic complications (p = 0.002), and pulmonary complications (p = 0.009). Conclusion. Our results show a high degree of correlation between the expected level of operative risk according to the EuroSCORE model and the frequency of postoperative nonlethal complications. There is a statistically significant difference in respect to frequency of heart rhythm disturbances, pulmonary and neurological complications and expected operative mortality.

scholarly journals Kidney Injury Molecule 1 (KIM-1) as an Early Predictor for Acute Kidney Injury in Post-Cardiopulmonary Bypass (CPB) in Open Heart Surgery Patients

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Nora A. Khreba ◽  
Mostafa Abdelsalam ◽  
A. M. Wahab ◽  
Mohammed Sanad ◽  
Rania Elhelaly ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Kidney Injury ◽  
Open Heart ◽  
Post Surgery ◽  
Significant Difference ◽  
Kidney Injury Molecule 1 ◽  
Early Predictor

Introduction. Postoperative acute kidney injury is associated with a higher mortality, a more complicated hospital course with longer hospital stay. Urinary kidney injury molecule 1 may play an important role as an early predictor of acute kidney injury post-cardiopulmonary in open heart surgery. Methods. We evaluated 45 patients who underwent open heart surgery from January 2016 to June 2016. Both urinary kidney injury molecule 1 and serum creatinine were evaluated before operation and 3hs and 24hs after operation. Acute kidney injury was diagnosed according to Kidney Disease: Improving Global Outcomes, 2012 guidelines. Results. In this study, 27 patients developed acute kidney injury. The three hour-post-surgery urinary kidney injury molecule 1 was significantly higher in the acute kidney injury group (P<0.015) and, at the same time, we did not find any significant difference in the serum creatinine levels between the two groups. Conclusion. Although serum creatinine is still the gold standard for diagnosis of acute kidney injury searching for other new markers is mandatory. Urinary kidney injury molecule 1 can be used as simple noninvasive and specific biomarker for early diagnosis of acute kidney injury.

scholarly journals The impact of colchicine in preventing postpericardiotomy syndrome; a double-blind clinical trial study

2020 ◽  
Vol 6 (1) ◽  
pp. e11-e11
Author(s):  
Navid Reaza Mashayekhi ◽  
Alireza Alisaeedi ◽  
Alireza Rostami ◽  
Parvin Soltani
Keyword(s):  
Clinical Trial ◽  
Incidence Rate ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Good Effect ◽  
Open Heart ◽  
Double Blind ◽  
Double Blind Clinical Trial ◽  
Significant Difference ◽  
The Impact

Introduction: Post-pericardiotomy syndrome is a relatively common complication after open heart surgery. In recent years, colchicine had a good effect on treatment of the pericarditis. Objectives: This study aimed to study the effect of colchicine to prevent post-pericardiotomy syndrome in patients who had open heart surgery. Patients and Methods: This double-blind clinical trial study was conducted on 240 patients undergone open heart surgery. Eligible patients were selected by simple sampling and randomly divided into two groups; 120 subjects in the experimental group receive colchicine (1 mg for patients greater than 70 kg and 0.5 mg for patients lower than 70 kg) and 120 subjects in the control group who received the placebo. Patients were followed up regarding the incidence of post-pericardiotomy syndrome after the surgery during hospitalization and in follow up visits in one month and six months after hospital discharges. Results: In total, the incidence rate of post-pericardiotomy syndrome was 33.7% (81 subjects). A significant difference of post-pericardiotomy syndrome between two groups was seen. We found post-pericardiotomy syndrome in 12.1% (29 patients) of colchicine group versus 21.6% (52 patients) in the placebo group (chi-square test). The incidence rate based on the Kaplan-Meier curve, in the second week to one month after the surgery, was lower in colchicine group while in third to the sixth month it had a constant trend. Conclusion: Colchicine is effective for prevention the post-pericardiotomy syndrome without any life-threatening complication.

scholarly journals Deep Sternal Wound Complications: An Overview of Old and new Therapeutic Options

2013 ◽  
Vol 6 ◽  
pp. OJCS.S11199 ◽  
Author(s):  
Leopold Rupprecht ◽  
Christof Schmid
Keyword(s):  
Clinical Practice ◽  
Gold Standard ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Therapeutic Options ◽  
Treatment Modalities ◽  
Wound Complications ◽  
Open Heart ◽  
Surgical Strategies ◽  
Tremendous Challenge

Deep sternal wound complications represent a significant problem in current open heart surgery and still pose a tremendous challenge to surgeons. Over the years, many treatment modalities have been proposed, but only few found their way into daily clinical practice of cardiothoracic surgeons. A gold standard has not been defined yet. This review was designed to give an overview of the preferred surgical strategies.

Sign in / Sign up

Export Citation Format

Share Document