Anesthesia for Common Cardiac Lesions

2018 ◽  
Author(s):  
Douglas Atkinson ◽  
Viviane G Nasr
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Surgical Procedures ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Preoperative Evaluation ◽  
Venous Pressure ◽  
Preoperative Assessment ◽  
Catheterization Laboratory

Congenital heart disease is the most common congenital malformation with an incidence of 4 to 10 per 1,000 live births. Anesthesiologists are required to manage these patients when they present for surgical or percutaneous interventions, including definitive and/or palliative procedures. The preoperative evaluation of the cardiac patient includes a thorough physical examination, laboratory testing, and diagnostic imaging such as echocardiography and magnetic resonance imaging. The perioperative management of children with cardiac disease requires a thorough understanding of the underlying pathophysiology, invasive monitoring such as arterial pressure and central venous pressure, and different surgical procedures and interventions in the catheterization laboratory. In addition, understanding cardiopulmonary bypass including perfusion, temperature, and acid-base is a must. This chapter presents a systematic approach for the preoperative assessment of children with cardiac disease and management on cardiopulmonary bypass and discusses the different surgical procedures and catheterization laboratory interventions, indications, and potential complications. This review contains 1 figure, 9 tables, and 23 references. Key Words: associated anomalies, cardiac surgical procedures, cardiopulmonary bypass, congenital heart disease, intraoperative monitoring, inotropes, interventional catheterization, preoperative evaluation, vasodilators

Cardiac complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

2008 ◽  
Vol 18 (S2) ◽  
pp. 196-201 ◽  
Author(s):  
Emile Antoine Bacha ◽  
David Cooper ◽  
Ravi Thiagarajan ◽  
Rodney C.G. Franklin ◽  
Otto Krogmann ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Circulatory Support ◽  
Cardiac Complications ◽  
Healthcare Intervention ◽  
Time Interval ◽  
Congenital Cardiac Disease

AbstractA complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the cardiac system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has prepared and defined a near-exhaustive list of cardiac complications, including intraoperative complications and cardiopulmonary bypass-related complications. These cardiac complications are presented in the following subgroups:1) Cardiac (general)2) Cardiac – Metabolic3) Cardiac – Residual and Recurrent cardiac lesions4) Arrhythmia5) Cardiopulmonary bypass and Mechanical circulatory support, and6) Operative/Procedural.Within each subgroup, complications are presented in alphabetical order. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, quality improvement initiatives, reporting of complications, and comparing strategies for treatment.

Endocrinal complications associated with the treatment of patients with congenital cardiac disease: consensus definitions from the Multi-Societal Database Committee for Pediatric and Congenital Heart Disease

2008 ◽  
Vol 18 (S2) ◽  
pp. 256-264 ◽  
Author(s):  
Heather Dickerson ◽  
David S. Cooper ◽  
Paul A. Checchia ◽  
David P. Nelson
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Healthcare Intervention ◽  
Time Interval ◽  
Quality Reporting ◽  
Cardiac Malformations ◽  
Comprehensive List ◽  
Congenital Cardiac Disease

AbstractA complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval.The MultiSocietal Database Committee for Pediatric and Congenital Heart Disease has set forth a comprehensive list of complications associated with the treatment of patients with congenital cardiac disease, related to cardiac, pulmonary, renal, haematological, infectious, neurological, gastrointestinal, and endocrinal systems, as well as those related to the management of anaesthesia and perfusion, and the transplantation of thoracic organs. The objective of this manuscript is to examine the definitions of operative morbidity as they relate specifically to the endocrine system. These specific definitions and terms will be used to track morbidity associated with surgical and transcatheter interventions and other forms of therapy in a common language across many separate databases.As surgical survival in children with congenital cardiac disease has improved in recent years, focus has necessarily shifted to reducing the morbidity of congenital cardiac malformations and their treatment. A comprehensive list of endocrinal complications is presented. This list is a component of a systems-based compendium of complications that will standardize terminology and thereby allow the study and quantification of morbidity in patients with congenital cardiac malformations. Clinicians caring for patients with congenital cardiac disease will be able to use this list for databases, initiatives to improve quality, reporting of complications, and comparing strategies of treatment.

The impact of actual and perceived disease severity on pre-operative psychological well-being and illness behaviour in adult congenital heart disease patients

2013 ◽  
Vol 24 (2) ◽  
pp. 275-282 ◽  
Author(s):  
Edward Callus ◽  
Elisabeth M. W. J. Utens ◽  
Emilia Quadri ◽  
Cristian Ricci ◽  
Mario Carminati ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Disease Severity ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Well Being ◽  
Illness Behavior ◽  
Psychological State ◽  
Illness Behaviour ◽  
Psychological Well Being

AbstractObjectives: The purpose of this study was to investigate whether the objective medical parameters related to congenital heart disease and patients’ ratings of cardiac disease severity were related to psychological well-being and illness behaviour during the pre-operative period.Methods: A total of 143 patients (63 male patients; 16–73 years old) with congenital heart disease evaluated the severity of their cardiac condition using a numerical rating scale ranging from 0, indicating the least severe condition, to 100, indicating the most severe condition. Psychological well-being was assessed using the Psychological General Well-Being Index (total score ≤60 indicating severe distress) and illness behaviour using the Illness Behavior Questionnaire.Results: Pre-operative psychological well-being was not related to the objective medical parameters reflecting cardiac disease severity. In contrast, total psychological well-being scores correlated significantly with patients’ subjective ratings of disease severity (p < 0.001). When compared with the reference values from the Italian population, the mean scores of the patients on psychological well-being were similar. As regards the Illness Behavior Questionnaire, the scores on denial were higher and those on hypochondria were lower compared with other hospitalised patients.Conclusions: This study shows that the perception of cardiac disease severity, and not the medical parameters in congenital heart disease, is related to the patients’ pre-operative psychological state. Thus, more importance needs to be given to assessing the patients’ pre-operative perception and psychological state independently of cardiac severity. Targeted interventions with regard to the cardiac condition are recommended.

scholarly journals Thrombin regulation in congenital heart disease after cardiopulmonary bypass operations

1994 ◽  
Vol 107 (2) ◽  
pp. 562-568 ◽  
Author(s):  
Sophronia O. Turner-Gomes ◽  
Lesley Mitchell ◽  
W.G. Williams ◽  
Maureen Andrew
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart

P4697Complications and mortality related to non-cardiac surgery in adult congenital heart disease: Results of a nationwide study including 20,450 cases

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G P Diller ◽  
E Freisinger ◽  
L Bronstein ◽  
J Koeppe ◽  
J Gerss ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Adverse Event ◽  
Heart Disease ◽  
Surgical Procedures ◽  
Congenital Heart ◽  
Cardiac Surgical Procedures ◽  
Mortality Rates ◽  
Adverse Event Rate ◽  
Major Adverse Event ◽  
Mortality And Morbidity

Abstract Background Adults with congenital heart disease (ACHD) represent a growing patient population with high morbidity and increasing health resource utilization. In addition to acute and chronic cardiac complications, these patients require numerous non-cardiac surgical procedures during their life-time. Limited data on the morbidity and mortality risk related to non-cardiac surgical procedures exist in contemporary CHD patients. The aim of this study was to analyse the frequency and outcome of non-cardiac surgical procedures in contemporary ACHD patients based on all hospital admissions in Germany between 2011 and 2016. Methods Based on the German diagnosis related groups data of patients treated between 2011 and 2016 we identified all ACHD patients treated surgically as inpatients for non-cardiac problems. The dataset contains information on patient demographics, primary and secondary diagnoses, interventional or surgical procedures, duration of stay and outcome including mortality. The primary endpoint of the study was surgery related mortality as well as major adverse events (defined as death or myocardial infarction, stroke, pulmonary embolism, sepsis or resuscitation). Results Overall, 48,872 ACHD cases were hospitalized during the study period. Of these, 20,450 (41.8%) were hospitalized for non-cardiac surgical procedures. The median age at surgery was 50.0 years and 62.9% of patients were male. The overall mortality rate following non-cardiac operations was 2.8% (95% CI 2.6–3.0%). The highest mortality rates were observed for procedure codes involving pharynx, larynx or trachea (27.2%; 95% CI: 22.3–32.1%) and lung surgery (15.4%; 95% CI: 13.3–17.8%). Abdominal surgery (9.2%; 95% CI: 7.7–10.9) and neurosurgical procedures (7.8%; 95% CI: 5.4–10.9) also had relative high mortality rates. The major adverse event rate overall was 12.7% (95% CI 11.7–12.7%). The highest major adverse event rates were observed for surgery of the airways (43.2%; 95% CI: 40.2%-46.4%). Conclusions Non-cardiac surgical procedures are common in ACHD patients and are associated with considerable mortality and morbidity in this cohort. Especially, surgical procedures involving the airways or neurosurgery emerged as risky procedures. However, even for routine abdominal or orthopaedic surgery considerable mortality and morbidity was observed. Overall, our data support careful pre-operative patient evaluation and concentration of surgical procedures at centres with extensive surgical and anaesthetic experience with ACHD patients.

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