scholarly journals Analyzing and comparing the impacts and outcomes of two different types of surgeries - Minimally Invasive Surgeries (MIS) and Conventional Surgeries (CVS) on patients suffering from Degenerative Mitral Valve Diseases

2021 ◽  
Vol 2 (1) ◽  
pp. 17-32
Author(s):  
Halim M ◽  
AlSayegh M ◽  
Umenne CA ◽  
Vadithya P ◽  
Panicker SV ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Conventional Surgery ◽  
Minimally Invasive Surgical ◽  
Clinical Benefits

Background: Degenerative Mitral Valve Disease (DMVD) is the most common cause of Mitral Regurgitation (MR) and the main reason for surgical intervention in patients with heart diseases. Traditionally, open-heart surgery or else sternotomy was the main surgical approach used until a few decades ago when Minimally Invasive Surgical (MIS) approaches came into existence. MIS approach is thought to have superior clinical outcomes while minimizing hospital and ICU stay; blood loss translating to fewer blood transfusions, and lower incidence of complications. Despite many promising institutional and regional results of benefits of MIS over the conventional surgery, the adoption of MIS worldwide in Mitral Valve Repair (MVR) has been so poor. There are still arguments on the surgical and clinical benefits of MIS and more importantly the cost and the expertise involved in conducting MIS. Objective: This study aimed at comparing the costs, clinical and surgical outcomes of MIS with conventional sternotomy MVR surgeries in patients with DMVD. Methods: Electronic databases such as MEDLINE, PubMed, Science Direct, and Google Scholar were searched for relevant peer-reviewed articles comparing costs and clinical outcomes of MIS with the conventional surgery/sternotomy in DMVD from January 2013 to November 2020. A total of 7 articles were identified as most relevant and therefore included in the meta-analysis. Results: Findings from the meta-analysis pointed out that repair of the mitral valve using MIS patients with DMVD has benefits such as short ICU, intubation and hospital duration; less loss of blood and therefore less need of blood transfusion; low postoperative infection rates; smaller incisions; early ambulation and return to activities of daily living over conventional surgery while maintaining similar costs of care and clinical outcomes as a sternotomy. Conclusions: Given the added advantages of MIS in mitral valve surgeries, cardiac surgeons should consider it over the conventional open surgeries in patients with DMVD. In this regard, more surgeons and nurses need to gain competency in conducting MIS through training and fellowships; hospitals need to acquire the needed infrastructure to enable the adoption of MIS.

Ultrafiltration in Pediatric Cardiac Surgery Review

2019 ◽  
Vol 10 (6) ◽  
pp. 778-788 ◽  
Author(s):  
Joel Bierer ◽  
Roger Stanzel ◽  
Mark Henderson ◽  
Suvro Sett ◽  
David Horne
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Heart Surgery ◽  
Fluid Overload ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Pediatric Cardiac Surgery ◽  
Significant Heterogeneity ◽  
Study Protocols ◽  
The Impact

Introduction: The use of cardiopulmonary bypass in pediatric cardiac surgery is associated with significant inflammation, fluid overload, and end-organ dysfunction yielding morbidity and mortality. For decades, various intraoperative ultrafiltration techniques such as conventional ultrafiltration, modified ultrafiltration (MUF), zero-balance ultrafiltration (ZBUF), and combination techniques (ZBUF-MUF) have been used to mitigate these toxicities and promote improved postoperative outcomes. However, there is currently no consensus on the ultrafiltration technique or strategy that yields the most benefit for infants and children undergoing open heart surgery. Methods: A librarian-conducted PubMed literature search from 1990 to 2018 yielded 90 clinical studies or publications on the various forms of ultrafiltration and the impact on physiologic markers and clinical outcomes. All publications were reviewed, summarized, and conclusions synthesized. The data sets were not combined for systematic or meta-analysis due to significant heterogeneity in study protocols and patient populations. Results: Modified ultrafiltration significantly promotes improved myocardial function, reduction in fluid overload, and reduced bleeding and transfusion complications. Furthermore, ZBUF has shown a consistent reduction in inflammatory cytokines and improved pulmonary function and compliance. There is conflicting evidence that MUF, ZBUF, and ZBUF-MUF culminate in reduced ventilation time and intensive care unit stay. Conclusion: Various modes of ultrafiltration have been shown to be associated with improved physiologic function or clinical outcomes in pediatric cardiac surgery. There are some inconsistent trial results that can be explained by heterogeneity in ultrafiltration, clinical staff preferences, and institution protocols. Ultrafiltration has some essential benefit as it is ubiquitously used at pediatric heart centers; however, the optimal protocol could be yet identified.

Minimally Invasive Fibrillating Heart Surgery: A Safe and Effective Approach for Mitral Valve and Surgical Ablation for Atrial Fibrillation

2013 ◽  
Vol 96 (2) ◽  
pp. 520-527 ◽  
Author(s):  
Paul S. Massimiano ◽  
Bobby Yanagawa ◽  
Linda Henry ◽  
Sari D. Holmes ◽  
Graciela Pritchard ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Heart Surgery ◽  
Surgical Ablation

scholarly journals Modulation of post-operative insulin resistance by pre-operative carbohydrate loading

2002 ◽  
Vol 61 (3) ◽  
pp. 329-336 ◽  
Author(s):  
Olle Ljungqvist ◽  
Jonas Nygren ◽  
Anders Thorell
Keyword(s):  
Insulin Resistance ◽  
Heart Surgery ◽  
Surgical Stress ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Length Of Hospital Stay ◽  
Cardiac Complications ◽  
Intravenous Glucose ◽  
Mortality And Morbidity

Insulin resistance develops as a response to virtually all types of surgical stress. There is an increasing body of evidence that suggests that insulin resistance in surgical stress is not beneficial for outcome. A recent large study in intensive-care patients showed that aggressive treatment of insulin resistance using intravenous insulin reduced mortality and morbidity substantially. Similarly, in burn patients, intensive insulin and glucose treatment has been shown to improve N economy and enhance skin-graft healing. In surgical patients insulin resistance has been characterized in some detail, and has been shown to have many similarities with metabolic changes seen in patients with type 2 diabetes. This finding may be important since insulin resistance has been shown to be one independent factor that influences length of stay. When patients about to undergo elective surgery have been treated with glucose intravenously or a carbohydrate-rich drink instead of overnight fasting, insulin resistance was reduced by about half. A small meta-analysis showed that when post-operative insulin resistance was reduced by preoperative carbohydrates, length of hospital stay was shortened. Overnight intravenous glucose at high doses improved post-operative N economy. This type of treatment has also been shown repeatedly to reduce cardiac complications after open-heart surgery. Furthermore, if the carbohydrates are given as a drink pre-operatively, pre-operative thirst, hunger and anxiety are markedly reduced. In summary, preventing or treating insulin resistance in surgical stress influences outcome. Fasting overnight is not an optimal way to prepare patients for elective surgery. Instead, pre-operative carbohydrates have clinical benefits.

scholarly journals Treatment of cyanotic heart diseases in children

2004 ◽  
Vol 132 (suppl. 1) ◽  
pp. 9-13
Author(s):  
Ida Jovanovic ◽  
Vojislav Parezanovic ◽  
Slobodan Ilic ◽  
Djordje Hercog ◽  
Milan Vucicevic ◽  
...  
Keyword(s):  
Heart Disease ◽  
Mortality Rate ◽  
Surgical Procedures ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Arterial Switch Operation ◽  
Open Heart Surgery ◽  
Age Groups ◽  
Mortality Rates ◽  
Cyanotic Heart Disease

Cyanotic heart diseases are relatively rare, but they are severe and heterogeneous congenital heart diseases, which require complex surgery. Development of different advanced surgical procedures, such as arterial switch operation (ASO), Fontan and its modifications, Norwood etc. operations, as well as better perioperative care significantly improved survival rate and quality of life of these children. The study group included 308 children treated for cyanotic heart disease in Yugoslavia, in the period January 2000 to July 2004. Some of them (239, 77.6%) were treated at the University Children?s Hospital in Belgrade, and others (69, 22.4%) in different institutions abroad. The age of the operated patients varied between 1 day and 19 years (median 12 months). The patients (pts) were divided into four groups, according to the disease and type of the operation. In the whole group of 308 patients treated due to cyanotic heart disease, there were 232 (75.3%) cases with open heart surgery and 76 (24.7%) with closed procedures. The mortality rate was significantly different between disease/operation groups, and age groups. Average mortality rates differed from 11.8% for palliative procedures to 12.5% for complete corrections. Mortality rate and achieved surgical results in treatment of chil?dren with cyanotic heart diseases were significantly worse than those published by leading cardiac surgery centers in the world. However, there is a clear tendency in introducing new surgical procedures, lowering the age at which the operation is done and decreasing the mortality rates.

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