Transvenous endocardial pacemaker pacing in thoracoscopic cardiac surgery

Background: Temporary cardiac pacing is frequently required during heart surgery due to life-threatening complications of arrhythmias. The conventional method of epicardial pacing could have risks such as bleeding and myocardial tears. Transvenous endocardial pacing provides another option. The efficiency of transvenous epicardial and endocardial pacing were compared in this study. Methods: We performed a retrospective study and reviewed medical records in patients who received either thoracoscopic cardiac surgery with transvenous endocardial pacing or median sternotomy with transvenous epicardial pacing between June 2019 and January 2021. Patients were assigned into two groups depending on the surgical type and pacing method. Preoperative patient characteristics and perioperative outcomes were collected. The efficiencies of endocardial and epicardial pacing were compared and analyzed in SPSS. Results: A total of 68 patients were included. Thirty-five (51.5%) patients were in the thoracoscopic cardiac surgery group with transvenous endocardial pacing. Thirty-three (48.5%) patients were in the median sternotomy group with transvenous epicardial pacing. Intensive care unit (ICU) time (p = 0.014), in-hospital duration (p = 0.036), operation time (p = 0.005), and the 24-h drainage volume (p < 0.001) showed significant differences between the two groups. There was no significant difference between the pre- and post-operative heart rate and rhythm compared between two groups. Conclusions: Compared with transvenous epicardial pacing, transvenous endocardial pacing showed no significant differences in heart rate and arrhythmia during the perioperative period. Transvenous endocardial pacing was also associated with better operative measurements.

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Treatment of supraventricular tachycardias in patients with non-cardiac surgery by dexmedetomidine during the perioperative period

10.21203/rs.3.rs-24724/v1 ◽

2020 ◽

Author(s):

Yan Xu ◽

CuiWen Hu ◽

Xuan Guo ◽

ZhiHong Hu ◽

Hui Shi ◽

...

Keyword(s):

Heart Rate ◽

Cardiac Surgery ◽

Therapeutic Effect ◽

Cardiac Disease ◽

Perioperative Period ◽

Adult Patients ◽

Significant Difference ◽

Supraventricular Tachycardias ◽

Group D ◽

Frequency Power

Abstract Background: Supraventricular tachycardias (SVTs) can increase the risk of adverse events in perioperative period. Previous studies have shown that application of dexmedetomidine (DEXm) combined anesthesia during surgery can significantly reduce postoperative cardiovascular and cerebrovascular complications and mortality in patients with cardiac disease. In fact, many anesthetic drugs have cardiac protection effects. However, it is a pity that these findings are not well applied in clinical practice to treat cardiac disease. Therefore, the aim of this study was to explore the therapeutic effect of DEXm on perioperative SVTs in adult patients with non-cardiac surgery. Methods: Forty-two patients with SVTs, aged between 35 and 61 years, were randomly divided into DEXm group (group D) and midazolam group (group M). The patients undergoing elective surgery in two groups were infused intravenously DEXm 0.5-1µg/kg or midazolam 0.06-0.08mg/kg using a micro-pump for 10 minutes, respectively. The the Observer’s Assessment of Alertness/Sedation (OAA/S) score, heart rate (HR), mean arterial pressure (MAP), pulse oxygen saturation (SpO2) and occurrence of SVTs, heart rate variability (HRV) including normalized low frequency power (LFnorm), normalized high frequency power (HFnorm) and the balance ratio of sympathetic to vagal tone (LF/HF) in two groups were recorded at T0 (before the infusion DEXm or midazolam), T1 (5 minutes after the infusion), T2 (at the end of the infusion), T3 (5 minutes after the end of the infusion), and T4 (10 minutes after the end of the infusion). Results: The OAA/S score in two groups at T4 was obviously decreased compared with T0. And the OAA/S score in group M was lower than in group D at T4 (P<0.05). Compared to T0, HR and MAP in two groups were obviously decreased, and HR and MAP in group D were apparently lower than group M from T1 to T4 (P<0.05). Three patients developed mild hypotension in group D. However, none of patients developed clinically significant bradycardia, hypotension, and anoxia. There was no significant difference for SpO2 from T0 to T4 in group D. Compared to T0 or group D, SpO2 in group M obviously decreased at T2 (P<0.05). In addition, SVTs in all patients were terminated until T4 in group D after DEXm infusion. However, only two patients were finally improved in group M. Compared to T0, HFnorm were elevated, and LFnorm and LF/HF were decreased from T1 to T4, furthermore, the changes in HFnorm, LFnorm and LF/HF had statistical significance (P<0.05) in group D. However, there was no significant difference for HFnorm, LFnorm and LF/HF in group M from T0 to T4.Conclusions: Perioperative use of dexmedetomidine had a significant therapeutic effect for supraventricular tachycardias without significant adverse effects in adult patients .Trial Registration: ClinicalTrials.gov Registration Number: NCT04284150 on 26th February 2020

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Anesthetic Effect of Compound Artevacaine Hydrochloride in Patients Undergoing Oral Implantation

Journal of Clinical and Nursing Research ◽

10.26689/jcnr.v5i4.2373 ◽

2021 ◽

Vol 5 (4) ◽

pp. 220-224

Author(s):

Chengxi Chi ◽

Mengmeng Zhao ◽

Jiajing He ◽

Yanli Wang

Keyword(s):

Blood Pressure ◽

Heart Rate ◽

Operation Time ◽

Control Group ◽

Study Group ◽

Research Subjects ◽

Implant Surgery ◽

Anesthetic Effect ◽

Significant Difference ◽

Oral Implant

Objective: To investigate and analyze the anesthetic effect of compound artevacaine hydrochloride in patients undergoing oral implantation. Methods: In this study, 60 patients receiving oral implant surgery in our hospital were selected as the research subjects, and the operation time was from July 2019 to March 2021. Patients were randomly selected and divided into groups for the study. 30 patients receiving lidocaine hydrochloride anesthesia were used as the control group, and 30 patients receiving compound artevacaine hydrochloride anesthesia were used as the research group. The anesthetic effect and safety of the two groups were compared and analyzed. Results: The anesthetic effect of the study group was significantly better than that of the control group (P < 0.05). The blood pressure and heart rate in the study group were significantly lower than those in the control group (P < 0.05). There was no significant difference in blood pressure and heart rate between the two groups before anesthesia (P > 0.05). There was no significant difference in the incidence of ADR between the two groups (P > 0.05). Conclusions: For patients undergoing oral implant surgery, choosing compound artevacaine hydrochloride as anesthetic drug has obvious anesthetic effect and can stabilize patients' life indexes. The anesthetic effect is obvious, and there is no obvious adverse reaction, and the clinical value is obvious.

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Vitamin D for prevention of sternotomy healing complications: REINFORCE-D trial

Trials ◽

10.1186/s13063-020-04920-z ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Michal Čečrle ◽

Dalibor Černý ◽

Eva Sedláčková ◽

Barbora Míková ◽

Vlasta Dudková ◽

...

Keyword(s):

Clinical Trial ◽

Cardiac Surgery ◽

Heart Surgery ◽

Soft Tissues ◽

Healing Process ◽

Hospital Readmissions ◽

Open Heart Surgery ◽

Median Sternotomy ◽

Complication Rates ◽

Mechanical Lung Ventilation

Abstract Background Most cardiac surgery patients undergo median sternotomy during open heart surgery. Sternotomy healing is an arduous, very complex, and multifactorial process dependent on many independent factors affecting the sternum and the surrounding soft tissues. Complication rates for median sternotomy range from 0.5 to 5%; however, mortality rates from complications are very variable at 7–80%. Low calcidiol concentration below 80 nmol/L results in calcium absorptive impairment and carries a risk of bone loss, which is considered as a risk factor in the sternotomy healing process. The primary objective of this clinical trial is to compare the incidence of all postoperative sternotomy healing complications in two parallel patient groups administered cholecalciferol or placebo. The secondary objectives are focused on general patient recovery process: sternal bone healing grade at the end of the trial, length of hospitalization, number of days spent in the ICU, number of days spent on mechanical lung ventilation, and number of hospital readmissions for sternotomy complications. Methods This clinical trial is conducted as monocentric, randomized, double-blind, placebo-controlled, with planned enrollment of 600 patients over 4 years, approximately 300 in the placebo arm and 300 in the treatment arm. Males and females from 18 to 95 years of age who fulfill the indication criteria for undergoing cardiac surgery with median sternotomy can be included in this clinical trial, if they meet the eligibility criteria. Discussion REINFORCE-D is the first monocentric trial dividing patients into groups based on serum calcidiol levels, and with dosing based on serum calcidiol levels. This trial may help to open up a wider range of postoperative healing issues. Trial registration EU Clinical Trials Register, EUDRA CT No: 2016-002606-39. Registered on September 8, 2016.

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Determination of frail state and association of frailty with inflammatory markers among cardiac surgery patients in a Central European patient population

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-190681 ◽

2020 ◽

Vol 76 (3) ◽

pp. 341-350

Author(s):

Rudolf Kiss ◽

Nelli Farkas ◽

Gabor Jancso ◽

Krisztina Kovacs ◽

Laszlo Lenard

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

European Population ◽

Central European ◽

Significant Difference ◽

Inflammatory Processes ◽

Hospital Deaths ◽

Development Methods ◽

Central European Population

INTRODUCTION: With the aging of the population, the screening of frail patients, especially before high-risk surgery, come to the fore. The background of the frail state is not totally clear, most likely inflammatory processes are involved in the development. METHODS: Our survey of patients over age of 65 who were on cardiac surgery were performed with Edmonton Frail Scale (EFS). Patients’ demographic, perioperative data, incidence of complications and correlations of inflammatory laboratory parameters were studied with the severity of the frail state. RESULTS: On the basis of EFS, 313 patients were divided into non-frail (NF,163,52%), pre-frail (PF,89,28.5%) and frail (F,61,19.5%) groups. Number of complications in the three groups were different (NF:0.67/patient, PF:0.76/patient, F:1.08/patient). We showed significant difference between NF and F in both intensive care and hospital stay, but there was no statistical difference between the groups in hospital deaths (NF:5/163, PF:3/89, F:5/61). We also found a significant difference between NF and F patients in preoperative fibrinogen-, CRP- and white blood cell count levels. CONCLUSIONS: We first present the incidence of frailty in patients with heart surgery in a Central-European population. According to our results, inflammatory processes are likely to play a role in the development of the frail state.

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The Effect of Combined Clopidogrel and Aspirin Therapy after Off-Pump Coronary Surgery

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3181bbc754 ◽

2009 ◽

Vol 4 (5) ◽

pp. 265-268 ◽

Cited By ~ 13

Author(s):

Emir Mujanovic ◽

Midhat Nurkic ◽

Jasmin Caluk ◽

Ibrahim Terzic ◽

Emir Kabil ◽

...

Keyword(s):

Artery Bypass ◽

Postoperative Bleeding ◽

Median Sternotomy ◽

Operation Time ◽

Graft Patency ◽

Off Pump ◽

Number Of Patients ◽

Significant Difference ◽

Group A ◽

Group B

Objective The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. Methods Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. Results Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. Conclusions Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.

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The Relationship between Heart Rate Deflection and Ventilatory Threshold in Children Following Heart Surgery

Pediatric Exercise Science ◽

10.1123/pes.7.3.263 ◽

1995 ◽

Vol 7 (3) ◽

pp. 263-269 ◽

Cited By ~ 1

Author(s):

Ralph K.L. Rogers ◽

Tony Reybrouck ◽

Maria Weymans ◽

Monique Dumoulin ◽

Marc Gewillig ◽

...

Keyword(s):

Heart Rate ◽

Heart Surgery ◽

Surgical Repair ◽

Ventilatory Threshold ◽

Linear Regression Analysis ◽

Accurate Predictor ◽

Graded Exercise Test ◽

Significant Difference ◽

Graded Exercise ◽

The Relationship

This study assessed the relationship between the VO2 measured at ventilatory threshold (VT) and the VO2 measured at the point of deflection from linearity of heart rate (HRD). Twelve children (10 boys and 2 girls) with a mean age of 11.3 years (±4.8) performed a graded exercise test to determine VT and HRD. All children had undergone surgical repair for d-transposition of the great arteries at approximately 13 months of age. Because of failure to demonstrate HRD, the data from 4 patients were excluded from statistical analysis. For the remaining 8 patients there was no significant difference between mean VO2 (ml/kg/min) at VT and HRD (26.6 ± 6.4 vs. 26.3 ± 6.8; p > 0.25). Linear regression analysis revealed a correlation of r = 0.92 between the VO2 measured at VT and the VO2 measured at HRD. Only 8 of the 12 patients (66%) in this study satisfied criteria needed to identify the HRD. Therefore HRD may be an accurate predictor of VT in most but not all children who have had surgery for d-transposition of the great arteries.

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Effect of Mechanical Ventilation During Cardiopulmonary Bypass On End-Expiratory Lung Volume in The Perioperative Period of Cardiac Surgery

10.21203/rs.3.rs-1039929/v1 ◽

2021 ◽

Author(s):

Lea Trancart ◽

Nathalie Rey ◽

Vincent Scherrer ◽

Véronique Wurtz ◽

Fabrice Bauer ◽

...

Keyword(s):

Mechanical Ventilation ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Lung Volume ◽

Perioperative Period ◽

Tertiary Teaching ◽

Significant Difference ◽

Residual Capacity ◽

Tertiary Teaching Hospital ◽

The Impact

Abstract Background Many studies explored the impact of ventilation during cardiopulmonary bypass period. However, its effect on Functional residual capacity or End Expiratory Lung Volume (EELV) has not been specifically studied. Our objective was to compare the effect of two ventilation strategies during cardiopulmonary bypass (CPB) on EELV. Methods observational monocenter study in a tertiary teaching hospital. Adult patients undergoing on-pump cardiac surgery by sternotomy were included and ventilated on the GE Carescape R860® ventilator. Maintenance of ventilation during CPB was left to the discretion of the medical team, with division between "ventilated" and "non-ventilated" groups afterwards. Iterative per and postoperative measurements of EELV were carried out by nitrogen washin-washout technique. Results 40 patients were included, 20 in each group. EELV was not significantly different between the ventilated versus non-ventilated groups at the end of surgery (1796±586ml vs. 1844±524ml; p=1). No significant difference between the two groups was observed on oxygenation, duration of mechanical ventilation, need postoperative respiratory support, occurrence of pneumopathy and radiographic atelectasis. Conclusion Maintaining mechanical ventilation during CPB does not seem to allow a better preservation of EELV in our population.

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Resting Energy Expenditure Early after Cardiac Surgery and Validity of Predictive Equations: A Prospective Observational Study

Annals of Nutrition and Metabolism ◽

10.1159/000518676 ◽

2021 ◽

pp. 1-8

Author(s):

Huijuan Ruan ◽

Qingya Tang ◽

Qi Yang ◽

Fangwen Hu ◽

Wei Cai

Keyword(s):

Cardiac Surgery ◽

Energy Expenditure ◽

Observational Study ◽

Prospective Observational Study ◽

Heart Surgery ◽

Resting Energy Expenditure ◽

Predictive Equations ◽

First Choice ◽

Significant Difference ◽

Resting Energy

Objective: Several predictive equations have been used to estimate patients’ energy expenditure. The study aimed to describe the characteristics of resting energy expenditure (REE) in patients undergoing mechanical ventilation during early postoperative stage after cardiac surgery and evaluate the validity of 9 REE predictive equations. Methods: This was a prospective observational study. Patients aged 18–80 years old, undergone open-heart surgery, were enrolled between January 2017 and 2018. The measured REE (mREE) was evaluated via indirect calorimetry (IC). The predictive resting energy expenditure (pREE) was suggested by 9 predictive equations, including Harris-Benedict (HB), HB coefficient method, Ireton-Jones, Owen, Mifflin, Liu, 25 × body weight (BW), 30 × BW, and 35 × BW. The association between mREE and pREE was assessed by Pearson’s correlation, paired t test, Bland-Altman method, and the limits of agreement (LOA). Results: mREE was related to gender, BMI, age, and body temperature. mREE was significantly correlated with pREE, as calculated by 9 equations (all p < 0.05). There was no significant difference between pREE and mREE, as calculated by 30 × BW kcal/kg/day (t = 0.782, p = 0.435), while significant differences were noted between mREE and pREE calculated by other equations (all p < 0.05). Taking the 30 × BW equation as a suitable candidate, most of the data points were within LOA, and the percentage was 95.6% (129/135). Considering the rationality of clinical use, accurate predictions (%) were calculated, and only 40.74% was acceptable. Conclusions: The 30 × BW equation is relatively acceptable for estimating REE in 9 predictive equations in the early stage after heart surgery. However, the IC method should be the first choice if it is feasible.

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Comparison of open and intracorporeal modified ureterosigmoidostomy (Mainz II) after laparoscopic radical cystectomy with bladder cancer

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02148-y ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Duo Zheng ◽

Junyao Liu ◽

Gongjin Wu ◽

Shujun Yang ◽

Chuang Luo ◽

...

Keyword(s):

Radical Cystectomy ◽

Urinary Diversion ◽

Operation Time ◽

Progression Free Survival ◽

Postoperative Recovery ◽

Oncologic Outcomes ◽

Perioperative Outcomes ◽

Estimated Blood Loss ◽

Significant Difference ◽

Urinary Control

Abstract Objective To compare perioperative and oncologic outcomes of open modified ureterosigmoidostomy urinary diversion (OMUUD) and intracorporeal modified ureterosigmoidostomy urinary diversion (IMUUD) following laparoscopic radical cystectomy (LRC). Patients and methods We retrospectively reviewed our single institutional collected database patients undergoing LRC from October 2011 to October 2019. The perioperative characteristics were compared between OMUUD and IMUUD, and overall survival (OS) and progression-free survival (PFS) were evaluated by the Kaplan-Meier method. Results Overall, 84 patients were included. OMUUD and IMUUD were performed in 63 (75%) and 21 (25%) patients, respectively. IMUUD patients demonstrated shorter postoperative length of stay (16.24 ± 3.91 days vs. 18.98 ± 7.41 days, P = 0.033), similar operation time (498.57 ± 121.44 vs. 462.24 ± 99.71, P = 0.175), similar estimated blood loss [400 (200–475) ml vs. 400 (200–700) ml, P = 0.095], and similar overall complication rate within 30 days (19.05% vs. 25.40%, P = 0.848) and 90 days (23.81% vs. 17.46%, P = 0.748). Complete urinary control rate was 87.3% (55/63) in the OMUUD group. In IMUUD, the complete urinary control rate was 90.5% (19/21). There was no significant difference in OS (χ2 = 0.015, P = 0.901) and PFS (χ2 = 0.107, P = 0.743) between the two groups. Conclusion IMUUD postoperative recovery is faster; other perioperative outcomes and oncology results are not significantly different with OMUUD. It is indicated that IMUUD can be utilized safely and effectively in the urinary diversion after LRC.

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Abstract 18701: Frequency and Contributing Factors to Diaphragm Paresis Following Pediatric Cardiac Surgery

Circulation ◽

10.1161/circ.130.suppl_2.18701 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Intikhab Zafurallah ◽

Osami Honjo ◽

Peter Laussen ◽

Cathy MacDonald ◽

Alejandro Floh

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Circulatory Arrest ◽

Median Sternotomy ◽

Hypothermic Circulatory Arrest ◽

Pediatric Cardiac Surgery ◽

Time Interval ◽

Long Term Outcome ◽

Icu Stay ◽

Ventilation Support

Introduction: Diaphragm paresis can occur as a complication of pediatric cardiac surgery that can prolong ventilation and length of ICU stay. Diaphragm plication (DP) may be necessary to improve respiratory mechanics and decrease duration of ventilation support. Early identification of patients who are likely to benefit from DP has not been studied. Methods: Patients at our institution diagnosed with diaphragm paresis between 2002 - 2012 were identified. Mode of diagnosis, demographics, operative procedures during index admission, and intervals of care were evaluated. Associations between predictors and DP were assessed by univariable and multivariable logistic regressions. Results: Diaphragm paresis was diagnosed in 161 patients following 6448 index surgeries, of whom 31 (19%) underwent DP (DP+). Paresis was diagnosed by ultrasound in 160 (99%) subjects at a median (IQR) time from surgery of 7 (3, 11) days in DP+ vs 10 (6, 19) days in DP- (p=0.02). DP was completed after a median (IQR) of 4 (1, 17) days after diagnosis. DP+ were younger in age [median (IQR) days DP+ 42 (14, 84) vs DP- 168 (28, 784); p<0.001], underwent surgery of higher RACHS-1 score [DP+ 3 (3, 4) vs DP- 3 (2, 4); p=0.02], and had a higher rate of hypothermic circulatory arrest [DP+ 14 (45%) vs DP- 23 (18%); p=0.001]. DP+ subjects had a rate of single ventricle physiology (32%), median sternotomy (94%), and bypass (87%) similar to DP- subjects. Only younger age (OR 1.003 per day, p=0.02) and use of hypothermic circulatory arrest (OR 3.06, p=0.01) remained significant on multivariable modeling. DP+ subjects had longer duration of ventilator support [DP+ 15 (9, 30) vs DP- 6.5 (3, 12.5) days; p<0.001] and ICU admission [DP+ 23 (18, 42) vs DP- 8 (5, 17) days; p<0.001]. However, ventilation was discontinued after a median of 1 (1,2) day after plication. The time interval from index surgery to diagnosis (EST 0.91, p<0.0001) and interval from diagnosis to DP (EST 0.94, p<0.0001; r2=0.91) were associated with a longer ICU stay even after adjusting for age and bypass time. Conclusion: Diaphragm paresis is common after congenital heart surgery. Earlier diagnosis and plication may shorten length of ventilation support and ICU stay, particularly in younger patients. Long-term outcome studies following DP are required.

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