Fast-track Cardiac Surgery in Children: Feasibility in Bangladeshi Setting

Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner. Keywords: Cardiac surgery; Congenital heart disease; Fast track; Hospital discharge. DOI: 10.3329/cardio.v3i1.6427Cardiovasc. j. 2010; 3(1): 50-54

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

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2021.78557 ◽

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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Abstract 3044: The Preoperative Utilization of Levosimendan (Preoperative Optimization) Reduced Mortality and Low Output Syndrome After Cardiac Surgery in Patients With Low Ejection Fraction (EF<25%).

Circulation ◽

10.1161/circ.116.suppl_16.ii_682-a ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Ricardo L Levin ◽

Marcela A Degrange ◽

Rafael Porcile ◽

Flavio Salvagio ◽

Norberto Blanco ◽

...

Keyword(s):

Cardiac Surgery ◽

Ejection Fraction ◽

Heart Surgery ◽

Open Heart Surgery ◽

Control Group ◽

Placebo Control ◽

P Value ◽

Open Heart ◽

Preoperative Optimization ◽

Low Ejection Fraction

Background: Patients with low ejection fraction (EF<25%) present high-risk of mortality and development of low output state (LOS) after cardiac surgery. The objective of this research was to evaluate the preoperative use of the calcium sensitizer Levosimendan (Levo) in patients with EF<25%, underwent open heart surgery. Thirty-day mortality and development of postoperative LOS were the primary end-points of the study. Methods: Patients with EF<25% and hemodynamic parameters of LOS (cardiac index<2.2 L/min/m2 and pulmonary artery occlusion pressure>15 mm Hg), underwent coronary bypass surgery between 12/01/2002 and 02/01/2007 were randomized to: preoperative infusion of Levo 0.1 mcg/Kg/min, 24 hours before surgery (Levo group-preoperative optimization), or placebo (Control group). LOS postoperative was defined for the same hemodynamic variables. A P value < 0.05 was considered significant Results: Two-hundred and twenty one patients fulfilled the inclusion criteria, being randomized 111 of them to Levo, and 110 patients to placebo. Both groups were comparable in their general and surgical characteristics. No withdrawal of Levo was required during the preoperative administration, with 8 patients showing hypotension episodes which was resolved with fluid infusions. There were not ventricular arrhythmias, supraventricular arrhythmias (with heart rate over 125) or preoperative ischemic events. The 30-day mortality was 3 patients in the Levo group (2.7%) versus 12 patients in the Control group (10.9%, P value 0.001, OR 0.23, IC95 0.05– 0.90). Seven patients in the Levo group developed postoperative LOS (6.3%) against 20 patients in the Control group (18.2%, P value <0.001, OR 0.30, IC95 0.11– 0.80) Conclusion: The preoperative optimization with Levosimendan reduced the operative mortality and the development of postoperative LOS in patients with EF<25% underwent open heart surgery. The infusion was safety no needing to withdraw it in any case. These findings could represent a new strategy to reduce the operative risk in this group of patients.:

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Intraoperative Low-volume Acute Normovolemic Hemodilution in Adult Open-heart Surgery

Anesthesiology ◽

10.1097/00000542-200208000-00013 ◽

2002 ◽

Vol 97 (2) ◽

pp. 367-373 ◽

Cited By ~ 37

Author(s):

Valter Casati ◽

Giovanni Speziali ◽

Cesare D'Alessandro ◽

Clara Cianchi ◽

Maria Antonietta Grasso ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Surgery ◽

Postoperative Bleeding ◽

Open Heart Surgery ◽

Valve Surgery ◽

Control Group ◽

Open Heart ◽

Acute Normovolemic Hemodilution ◽

Normovolemic Hemodilution ◽

Low Volume

Background Recently, various studies have questioned the efficacy of intraoperative acute normovolemic hemodilution (ANH) in reducing bleeding and the need for allogeneic transfusions in cardiac surgery. The aim of the present study was to reevaluate the effects of a low-volume ANH in elective, adult open-heart surgery. Methods Two hundred four consecutive adult patients undergoing cardiac surgery were prospectively randomized in a nonblinded manner into two groups: ANH group (103 patients), where 5-8 ml/kg of blood was withdrawn before systemic heparinization and replaced with colloid solutions, and a control group, where no hemodilution was performed (101 patients). Procedures included single and multiple valve surgery, aortic root surgery, coronary surgery combined with valve surgery, or partial left ventriculectomy. The purpose of the study was to evaluate the efficacy of ANH in reducing the need for allogeneic blood components. Routine hematochemical evaluations, perioperative blood loss, major complications, and outcomes were also recorded. Results No differences were found between the groups regarding demographics, baseline hematochemical data, and operative characteristics. There was no difference in the amount of transfusions of packed red cells, fresh frozen plasma, platelet concentrates, total number of patients transfused (control group, 36% vs. ANH group, 34.3%; P = 0.88), and amount of postoperative bleeding (control group, 412 ml [313-552 ml] vs. ANH group, 374 ml [255-704 ml]) (median [25th-75th percentiles]); P = 0.94. Further, perioperative complications, postoperative hematochemical data, and outcomes were not different. Conclusions In patients undergoing elective open-heart surgery, low-volume ANH showed lack of efficacy in reducing the need for allogeneic transfusions and postoperative bleeding.

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The Effect of Preoperative Oral Chlorhexidine Rinse on Ventilator Associated Pneumonia and ICU Mortality After Open Heart Surgery

Journal of Cardio-Vascular-Thoracic Anaesthesia and Intensive Care Society ◽

10.5222/gkdad.2021.33602 ◽

2021 ◽

Author(s):

İbrahim Uğur ◽

Nurgül Yurtseven ◽

Senem Polat ◽

Sibel Yılmaz Ferhatoğlu ◽

Seyda Ocalmaz

Keyword(s):

Cardiac Surgery ◽

Hospital Stay ◽

Heart Surgery ◽

Open Heart Surgery ◽

Computer Software ◽

Ventilator Associated Pneumonia ◽

Elective Cardiac Surgery ◽

Group 2 ◽

Software Group ◽

Group 1

Objective: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the intensive care unit (ICU). VAP develops 10-20% of patients in 48 hours of mechanical ventilation. In this study, it was aimed to determine the effect of preoperative oral chlorhexidine rinse on VAP and mortality in patients undergoing open cardiac surgery. Methods: 300 patients who were planned to undergo elective open cardiac surgery were included in this study. Patients were prospectively randomized into two groups by a computer software. Group 1: Patients brushing their teeth and then gargling with 0.12% chlorhexidine before bedtime at the last night before surgery and 15 minutes before going to the operating room. Group 2, It consisted of patients only brushing their teeth. Results: VAP was seen in 3 patients (2.12%) in Group 1 and in 12 (8.10%) patients in Group 2 (p<0.02). Duration of intubation was 15±7.40 hours for Group 1 and 23 32.01 for Group 2. These differences were statistically significant (p <0.01). Although duration of ICU stay and hospital stay in Group 1 are shorter than in Group 2 but it was not statistically significant (p>0.05). There was no difference in mortality (p>0.05). Conclusion: Consequently, chlorhexidine gluconate rinse before elective cardiac surgery reduced the VAP rate and duration of intubation but did not change the mortality rate and the length of ICU and hospital stay. On the other hand we think these results would be change in large multicentric studies.

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Short-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country, with comparison with an historical control group: an observational study

Open Heart ◽

10.1136/openhrt-2021-001706 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001706

Author(s):

Ståle Wågen Hauge ◽

Havard Dalen ◽

Mette E Estensen ◽

Robert Matongo Persson ◽

Sintayehu Abebe ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Low Income ◽

Heart Surgery ◽

Open Heart Surgery ◽

Control Group ◽

First Year ◽

Open Heart ◽

Surgical Group ◽

Rheumatic Heart

ObjectivesRheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment.MethodsClinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital’s waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis.ResultsSurvival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working.ConclusionsCardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.

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Outcome of open heart surgery in patients with age above 75 years.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.07.4776 ◽

2020 ◽

Vol 27 (07) ◽

pp. 1521-1526

Author(s):

Muhammad Mujtaba Ali Siddiqui ◽

Muhammad Zubair Ahmad Ansari ◽

Abdul Ghaffer

Keyword(s):

Hospital Stay ◽

Neurological Deficit ◽

Heart Surgery ◽

Operative Mortality ◽

Open Heart Surgery ◽

Type Ii ◽

Open Heart ◽

Mortality And Morbidity ◽

Output State ◽

Icu Stay

Objectives: Open heart surgery is considered as high risk procedure in elderly patients. We study the operative outcomes of open heart surgery in patients of age above 75 years in geography of world where life expectancy is around 67 years. Study Design: Retrospective Study. Setting: Research of Rawalpindi Institute of Cardiology (RIC). Periods: From January 2014 to December 2018. Material & Methods: Demographic and baseline characteristics of patients were retrieved from cardiac surgery database (cascade, Lahore) of RIC. For all patients who underwent open heart surgery and had age above 75 years. Operative mortality, neurological outcome, low cardiac output state(LCOS), peri-operative myocardial infarction, postop.erative atrial fibrillation (POAF), acute kidney injury (AKI), chest reopening, ICU stay, hospital stay and 1-year survival etc. Are analyzed from retrieved data. Results: Operative mortality is 5.71%, type II neurological deficit is 16.42% and POAF is 25%. Incidence of peri-operative mi, lcos, aki and chest reopening etc is low along with acceptable ICU stay and hospital stay durations. 1-years survival is 95.46%. Conclusion: open heart surgery can be offered to patients with age above 75 years with low operative mortality and morbidity except with relatively higher incidence of type ii neurological deficit and POAF. 1- years survival is impressive with figures of 95.46%.

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Modified Ultrafiltration Reduces Morbidity After Adult Cardiac Operations

Circulation ◽

10.1161/circ.104.suppl_1.i-253 ◽

2001 ◽

Vol 104 (suppl_1) ◽

Author(s):

Giovanni Battista Luciani ◽

Tiziano Menon ◽

Barbara Vecchi ◽

Stefano Auriemma ◽

Alessandro Mazzucco

Keyword(s):

Cardiopulmonary Bypass ◽

Hospital Stay ◽

Heart Surgery ◽

Open Heart Surgery ◽

Group Versus ◽

Control Group ◽

Continuous Variables ◽

Transfusion Requirements ◽

The Impact ◽

Cardiac Operations

Background Extracorporeal circulation contributes to morbidity after open-heart surgery by causing a systemic inflammatory reaction. Modified ultrafiltration is a technique able to remove the fluid overload and inflammatory mediators associated with use of cardiopulmonary bypass. It has been shown to reduce morbidity after cardiac operations in children, but the impact on adult cardiac procedures is unknown. Methods and Results Five hundred seventy-three consecutive adult patients were prospectively randomized to either ultrafiltration after cardiopulmonary bypass (treatment) or to no ultrafiltration (control). Parsonnet score was used to assess the severity of the patients’ clinical conditions. Analysis was done with Student’s t test or Mann-Whitney U test for continuous variables and Fisher’s exact test or Pearson’s χ 2 for discrete variables. Hospital mortality was 2.5% (7 of 284) in the treatment group versus 3.8% (11 of 289) in the control group ( P =0.357). Hospital morbidity was lower in treated patients (66 of 284 [23.2%] versus 117 of 289 [40.5%], P =0.0001). Cardiac morbidity was similar (26 of 284 [9.1%] versus 35 of 289 [12.1%], P =0.251), whereas significantly lower rates of respiratory (20 of 284 [7.0%] versus 36 of 289 [12.5%], P =0.029), neurological (5 of 284 [1.8%] versus 14 of 289 [4.8%], P =0.039), and gastrointestinal (0 of 284 versus 4 of 289 [1.4%], P =0.044) complications were found in treated patients. Transfusion requirements were also lower in treated patients (1.66±2.6 versus 2.25±3.8 U/patient, P =0.039). Duration of intensive care (39.9±49.2 versus 46.3±72.8 hours, P =0.218) and hospital stay (7.6±3.5 versus 7.9±4.4 days, P =0.372) were comparable. Conclusions Modified ultrafiltration after cardiopulmonary bypass is associated with a lower prevalence of early morbidity and lower blood transfusion requirements. The impact on length of hospital stay needs further analysis. Routine application of modified ultrafiltration after adult cardiac operations is warranted.

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

The Egyptian Cardiothoracic Surgeon ◽

10.35810/ects.v1i1.127 ◽

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.

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Effects of Obesity on Mortality and Morbidity in High-Risk Open Heart Surgery Patients

Annals of Cardiology and Vascular Medicine ◽

10.33582/2639-4383/1044 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Hulya Yilmaz Ak ◽

◽

Yasemin Ozsahin ◽

Mehmet Ali Yesiltas ◽

Ismail Haberal ◽

...

Keyword(s):

Cardiac Surgery ◽

High Risk ◽

Heart Surgery ◽

Open Heart Surgery ◽

Obese Group ◽

Open Heart ◽

Mortality And Morbidity ◽

High Risk Patients ◽

Risk Patients

Background: The results of studies on the effect of obesity on mortality and morbidity in cardiac surgery are limited and contradictory. Today, the population of patients referred for open heart surgery is changing, and high-risk patients now represent a significant proportion of surgical candidates. In this study, the effect of obesity on mortality and morbidity in high risk patients in cardiac surgery was investigated retrospectively. Methods: This study was carried out by retrospectively evaluating the data of patients who had undergone adult Open Heart Surgery (OHS) in a university hospital operating room in the last 5 years (2015-2020). A total of 924 patients were examined in the study. The current online version of EuroSCORE (www.euroscore.org) was used and was calculated separately for all patients. The information in the hospital data system, preoperative evaluation forms, anesthesia follow-up slips, perfusion cards and intensive care, nurse follow-up forms of the patients (n = 95) calculated as EuroSCORE ≥ 6 were examined. The patients were divided into two groups as obese (body mass index (BMI) ≥ 30kg / m²) and non-obese (BMI <30kg / m²). Results: In the preoperative data, patients with diabetes mellitus in the obese group were statistically higher than the non-obese group (p=0.018). Mortality rate did not differ according to the groups (p> 0.05). Conclusion: In this study, no additional negative risk of obesity, which is considered to be an important risk factor for heart diseases, on cardiac surgery was determined.

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