scholarly journals Treatment of non-healing sternum wound after open-heart surgery with allogenic platelet-rich plasma and fibrin glue-preliminary outcomes

2013 ◽  
Vol 46 (03) ◽  
pp. 538-542 ◽  
Author(s):  
Mohammad Abbasi Tashnizi ◽  
Mohammad Esmail Khayami ◽  
Hamid Reza Rahimi ◽  
Aliasghar Moeinipour ◽  
Ahmad Amouzeshi ◽  
...  
Keyword(s):  
Fibrin Glue ◽  
Heart Surgery ◽  
Platelet Rich Plasma ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Systemic Complications ◽  
Healing Wound ◽  
Life Threatening ◽  
Invasive Method

ABSTRACT Introduction: Non-healing wound in the sternal region after coronary arteries bypass graft surgery is a serious complication. For healing a chronic wound, several novel approaches have been proposed recently such as using bone marrow stem cells, platelets and fibrin glue (PFG); but a non-invasive method is highly desirable in the first approach for treatment. The current study was undertaken to evaluate the effect of the combination of PFG in one treatment. Materials and Methods: We report on the treatment of six patients with life-threatening chronic sternum wounds, which caused septicemia with multi-drug resistant pathogens. The ulcers were extensively debrided initially and were measured and photographed at weekly intervals. The combination of PFG was applied topically on the wound after every 2 days. Results: The wounds were completely closed in five patients and significantly reduced in size in one. There was no evidence of local or systemic complications and any abnormal tissue formation, keloid or hypertrophic scarring. Conclusions: Our study suggests, in the first approach, PFG can be used safely in order to heal a non healing sternum wound following coronary artery bypass surgery.

Cardiac rehabilitation of older patients

2003 ◽  
Vol 13 (3) ◽  
pp. 241-255 ◽  
Author(s):  
Robert West
Keyword(s):  
Major Trauma ◽  
Heart Surgery ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Developed Countries ◽  
The Other ◽  
Co Morbidity ◽  
Life Threatening

Rehabilitation is a necessary step in the process of recovery from most serious illness and from many clinical interventions. The nature of rehabilitation, and the form of any programme of rehabilitation provided to help patients with this process, depends greatly on patient, illness, treatment or intervention, co-morbidity and on the availability of appropriate services. Heart disease is the leading cause of death in most developed countries and acute myocardial infarction (MI) is a major cause of acute medical admissions to hospitals, and revascularization by coronary artery bypass graft surgery (CABG) is a leading surgical intervention. Both MI and CABG involve a day or more in intensive care followed by several days recuperation in hospital. There is a fairly obvious case for rehabilitation for patients surviving the truly life-threatening experience of MI (20% sudden deaths and a further 10% die within 24 hours of onset of pain), and for patients following the major ‘trauma’ of open heart surgery (operative mortality about 1%). The specific needs of these two groups may differ because their experiences differ; one medical the other surgical, and, possibly more significantly, one unexpected, the other planned.

A Case of Organic Mania Associated with Open Heart Surgery

1994 ◽  
Vol 7 (1) ◽  
pp. 8-12 ◽  
Author(s):  
Kathryn J. Kotrla ◽  
Ranjit C. Chacko ◽  
Shawn A. Barrett
Keyword(s):  
Heart Surgery ◽  
Single Photon ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Photon Emission ◽  
Open Heart Surgery ◽  
Brain Regions ◽  
Single Photon Emission ◽  
Computed Tomographic ◽  
Single Photon Emission Computed

Organic mania has been reported to have multiple etiologies. A case is described of a patient who developed mania following a coronary artery bypass graft and mitral valve replacement. Cerebral abnormalities were not detected by computed tomographic or magnetic resonance imaging scans, but an area of dysfunction was found using single photon emission computed tomographic (SPECT) imaging. The lesion resolved when the patient became clinically asymptomatic. The area of decreased cerebral perfusion associated with the patient's mania was in an atypical location, raising questions about which brain regions can result in well-defined psychiatric syndromes.

Recent Developments in Myocardial Protection: Retrograde Cardioplegia

1997 ◽  
Vol 5 (1) ◽  
pp. 2-7
Author(s):  
Anthony L Panos ◽  
Salim Aziz
Keyword(s):  
Coronary Sinus ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Ease Of Use ◽  
Blood Cardioplegia ◽  
Catheter Design ◽  
Coronary Sinus Catheter ◽  
Recent Developments

In recent years there has been increasing use of coronary sinus perfusion to deliver cardioplegic solutions during open-heart surgery. This has been aided by advances in coronary sinus catheter design and by easier methods of cannula insertion. Coronary sinus perfusion has been used with both intermittent crystalloid and blood cardioplegia and has recently evolved to include retrograde continuous normothermic blood cardioplegia. Coronary sinus perfusion has several advantages including safety, ease of use (with a single cannula placed out of the operative field), usefulness in patients with significant aortic regurgitation, redo coronary artery bypass graft surgery, and acute myocardial infarction. However, there are continuing concerns about the distribution of retrograde perfusion, preservation of right ventricular function, dislodgment of the coronary sinus catheter (and resulting ischemia during surgery), and damage to the coronary sinus.

scholarly journals Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Abdorasoul Anvaripour ◽  
Forouzan Yazdanian ◽  
Mohammad-Zia Totonchi ◽  
Houshang Shahryari
Keyword(s):  
Coronary Artery ◽  
Mitral Valve ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Venous Catheter ◽  
Mitral Valve Stenosis ◽  
Artery Disease ◽  
Vessel Coronary Artery

A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

scholarly journals Coronary Artery Bypass Graft Surgery in Tanzania: 5 Years of Experience at Jakaya Kikwete Cardiac Institute

2020 ◽  
Author(s):  
Mohamed Yakubu Janabi ◽  
Evarist Nyawawa ◽  
Bashir Nyangasa ◽  
William Ramadhani Ramadhan ◽  
Ramadhani Hassan Hamis ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
World Health

Abstract Cardiac surgery is not widely available in most developing countries, and most patients have no choice but to live in morbid conditions and managed conservatively or the few who are referred abroad for surgical procedures costs the respective countries millions of hard earned foreign currency. The World Health Organization projects that over the next ten years the continent of Africa will experience the largest increase in death rates from cardiovascular disease. The Jakaya Kikwete Cardiac Institute (JKCI) is a government owned National Specialized and Teaching Hospital that serves patients from all the regions of the United Republic of Tanzania with a population of nearly 60,000,000 people and also serves beyond the borders (Rwanda, Burundi, DR Congo, South Sudan, Comoro, Malawi and Zambia) for advanced cardiovascular medical, intervention, vascular and open heart surgery, the Institute was established in 2015. Methods: Here we report all patients who underwent coronary artery bypass surgery grafting only performed at the Centre since its inauguration in 2015- till 2019. Data were collected for basic demography, diagnosis, investigations, clinical and surgical outcome parameters. Results: A total of 85 patients with heart diseases and underwent coronary artery bypass surgery grafting (CABG) are analysed in this study. There were 64 (75%) male and 21 (25%) female patients. Their age ranged from 41–85 years old with almost half 42 (49%) of the cohort being between the age between 61–70 years old. Most of the patients had two or more grafts and an internal mammary artery graft was used over 80% of the procedures. The overall 30-day mortality was 7.1%, incidence of stroke 0.2%, duration of mechanical ventilation was an average of 9.98 hours and intensive care unit (ICU) stay post CABG was an average of 6.48 days and final discharge from the centre ranged from 10–16 days.Conclusion: This study has demonstrated that coronary artery bypass surgery grafting in low/middle income country is safe and feasible. A sustainable program demands highest level of governmental support as seen in this case, and a dedicated multidisciplinary team with profound know how in cardiac pathologies. Furthermore, a need for good local data to know the prevalence of coronary disease is mandatory to determine the magnitude of coronary artery disease in each country.

Neutrophil function and cardiopulmonary bypass in humans. The effects of glucose and non-glucose containing bypass pump priming fluids

Perfusion ◽  
1986 ◽  
Vol 1 (2) ◽  
pp. 103-116 ◽  
Author(s):  
PT Conroy ◽  
MJ Elliott ◽  
PN Platt ◽  
M. Holden
Keyword(s):  
Cardiopulmonary Bypass ◽  
Whole Blood ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Open Heart Surgery ◽  
Neutrophil Function ◽  
Polymorphonuclear Neutrophil ◽  
Blood Glucose Concentrations ◽  
Glucose Group

Defective polymorphonuclear neutrophil function during cardiopulmonary bypass (CPB) has been implicated as a cause of postoperative infection following open-heart surgery. Neutrophil function is known to be impaired in poorly controlled diabetics with elevations of blood glucose concentrations of the order which occur frequently during CPB when glucose containing priming fluids are used. Neutrophil function, as measured by bactericidal assay, and neutrophil and whole blood luminol dependent chemiluminescence, was studied in two groups of 1 2 patients undergoing coronary artery bypass graft surgery. Patients received either a glucose or non-glucose containing bypass pump-priming fluid. Postoperatively neutrophil luminol-dependent chemiluminescence was significantly increased in both groups (glucose prime groups p < 0.01, non-glucose prime group p < 0.01). Whole blood chemiluminescence was increased significantly intra and postoperatively in the glucose prime group ( p < 0.02, p < 0.02 respectively) but the increase was not significant in the non-glucose prime group. Bactericidal activity remained unchanged during and after surgery in both groups (mean bactericidal index intraoperatively 96.4 glucose group, 96.2 non-glucose group; postoperatively 99.7 glucose group, 99.7 non-glucose group). These data suggest that glucose containing bypass priming fluids do not modulate significantly the function of circulating neutrophils after CPB. Neutrophil function was not decreased after surgery, and other factors may be responsible for the reported higher incidence of bacterial infection after CPB.

Off-Pump Coronary Artery Bypass Surgery May Produce a Hypercoagulable Patient

2005 ◽  
Vol 6 (2) ◽  
pp. 94 ◽  
Author(s):  
Robert L. Quigley ◽  
David W. Fried ◽  
John Pym ◽  
Richard Y. Highbloom
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Anticoagulation Therapy ◽  
Maximum Amplitude ◽  
Platelet Activity ◽  
Off Pump ◽  
Pump Coronary Artery Bypass

<P>Background: The incidence of thromboembolic events following traditional open heart surgery has not been clinically significant. However, with beating heart surgery, for which cardiopulmonary bypass (CPB) is not required, the incidence of spontaneous intravascular thrombosis may be similar to that encountered after general surgeries. Compounding this risk is that many cases of off-pump coronary artery bypass (OPCAB) surgery are reserved for the elderly patient with multiple comorbidities. The few studies to date that have assessed the coagulation profile in OPCAB patients have been limited to the first 24 hours after surgery. </P><P>Methods: We prospectively studied 17 OPCAB and 6 on-pump patients over 4 days (hospital course) with daily thromboelastography. A coagulation index (CI) (reflecting R and K times, a angle, and maximum amplitude [MA]) was calculated for the patients, who served as their own controls. </P><P>Results: The OPCAB patients demonstrated 3 days postoperatively a 17% increase in coagulation compared with the baseline. Specifically, the CI consistently revealed an elevation in the a angle and the MA, both of which reflect increased fibrinogen and platelet activity. On the other hand, 3 days following surgery the CI of the CPB group was tightly clustered around their respective baseline CI values, which had recovered from a significant decrease immediately after surgery. </P><P>Conclusion: A state of hypercoagulability, as measured by thromboelastography, exists in the OPCAB patient beyond the first postoperative day, and this finding suggests that prophylactic postoperative anticoagulation therapy targeting fibrinogen and platelet activity may be indicated for these patients.</P>

Abstract 218: Major Therapeutic Cardiac Procedures in the Very Elderly: All-Payer Race-Gender Disparities and Temporal Trends

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Elizabeth B Pathak ◽  
Amit P Pathak
Keyword(s):  
Hospital Mortality ◽  
White Women ◽  
Heart Surgery ◽  
Bypass Graft ◽  
Temporal Trends ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Very Elderly ◽  
Cardiac Procedures ◽  
Race Ethnicity

Objectives: Major therapeutic cardiac procedures include open heart surgery (e.g., coronary artery bypass graft, valv/septum repairs) (OPEN), insertion/repair of pacemakers, internal defibrillators, and related devices (PACE), and percutaneous coronary intervention (PCI). The use of these procedures among patients aged > 85 years has not been well-described. Methods: Inpatient records for adults aged > 85 years were obtained from a comprehensive all-payer hospital discharge database for Florida for 2006-2011. Major cardiac procedures were identified by ICD-9-CM codes. Patient race/ethnicity (non-Hispanic White, Hispanic, non-Hispanic Black), gender, payer, principal/secondary diagnoses, and in-hospital mortality were analyzed for each procedure type. Annual procedure rates were calculated using US Census population estimates. Results: There were 2,497,573 person-years at risk for the period 2006-2011, with a total of 1,355,308 inpatient hospitalizations in this very elderly population. Medicare coverage ranged from 88% in Hispanic men (HM) to 96% in White women (WW). Procedure rates were higher in Medicare patients vs. all other payers. PACE was the most common major cardiac procedure (n=32,338), followed by PCI (n=17,046) and OPEN (n=5,916). Population rates of each procedure varied significantly by race/ethnicity and gender (see Figure for PACE rates). In 2011, the rate of PCI for White men (WM) (89 per 10,000, 95% CI 84 to 94) was 20% higher compared to HM, 70% higher compared to Black men (BM), 80% higher than WW and Black women (BW), and 130% higher than Hispanic women (HW). The open heart surgery rate for WM (41 per 10,000, 95% CI 38 to 45) was significantly higher than all other groups: 1.6 times the rate for HM, 2.9 times the rate for WW, 4.1 times the rate for HW, 8.2 times the rate for BM and 10.3 times the rate for BW. In-hospital mortality rates were 1.4% for PACE, 4.3% for PCI, and 8.2% for OPEN. Temporal trends showed declining rates for all procedures over the study period. Conclusions: Major therapeutic cardiac interventions are common among the very elderly. Greater inclusion of very elderly patients in clinical trials and outcome studies is necessary to establish the survival and quality of life benefits of these procedures for patients near the end of life.

Abstract 266: Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation Among Patients With Bradyarrhythmias Following Cardiac Surgery: Insights From the National Inpatient Sample Database

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Karol Quelal ◽  
Olakanmi Olagoke ◽  
Jose Baez
Keyword(s):  
Cardiac Surgery ◽  
Valve Replacement ◽  
Heart Surgery ◽  
Artery Bypass ◽  
Open Heart Surgery ◽  
Pacemaker Implantation ◽  
Permanent Pacemaker ◽  
Hospital Death ◽  
National Inpatient Sample ◽  
Permanent Pacemaker Implantation

Introduction: Significant atrioventricular blocks and bradyarrhythmias are known complications of open-heart surgery. These are frequently transient, however, some patients go on to need a permanent pacemaker (PP). We sought to describe the incidence, predictors, and outcomes of PP implantation among patients admitted for cardiac surgery who develop bradyarrhythmias. Methods: We queried the National Inpatient Sample (NIS) database from 2010 to 2014 for adults admitted for surgical valve replacement, valvuloplasty or coronary artery bypass grafting (CABG) who had bradyarrhythmias during the admission using the appropriate ICD codes. We identified patients who had permanent pacemaker implantation documented during the admission. Categorical and continuous variables were compared using the chi-square and student's t-test. Predictors of PP implantation and in-hospital mortality were evaluated by logistic regression. Results: Of the 1402930 patients who underwent cardiac surgery, 94748 patients had bradyarrhythmias defined as sinoatrial node dysfunction (SND) and/or atrioventricular block (AVB) during hospitalization. The primary procedure was identified as valve replacement in 50.3% (47615 of 94748), CABG in 29.9% (27622 of 94748) and valvuloplasty in 8.7% (8248 of 94748). SND was found in 29.9% (28372 of 94748) and AVB in 76% (72017 of 94748). Permanent pacemaker implantation was done in 39.3% (37246 of 94748). Valve replacement was the most common surgery associated with PP implantation [58% (21682 of 37246) compared to 21.5% in CABG (8007 of 37246) and 7.7% in valvuloplasty (2882 of 37246), p < 0.001). Female sex aOR 1.36 (95% CI 1.31 - 1.40), young age 18 - 44 years aOR 1.36 (95% CI 1.24 - 1.49), Asiatic and Hispanic origin aOR 1.36 (95% CI 1.23 - 1.51), aOR 1.25 (95% CI 1.17 - 1.34) respectively, diabetes mellitus with chronic complications aOR 1.16 (95% CI 1.09 - 1.24), drug abuse aOR 1.38 (95% CI 1.21 - 1.55) were associated with higher odds of pacemaker implantation. African American origin aOR 0.79 (95CI 0.74 - 0.85), AIDS aOR 0.33 (95% CI 0.17 - 0.67), south hospital region aOR 0.89 (95% CI 0.85 - 0.93), no-charge admissions aOR 0.66 (95% CI 0.49 - 0.89) were associated with a lower odds of PPM implantation. Death during hospitalization was found in 3% of the patients. After multivariable regression, PP implantation was associated with a lower likelihood of in-hospital death aOR 0.45 (95% CI 0.41 - 0.50). Conclusion: Approximately one-third of the patients hospitalized for cardiac surgery related to AVB and/or SND were implanted a permanent pacemaker. Factors like age, sex, race and comorbidities determine the likelihood of this procedure that has a significant impact on mortality. Having a better insight into these predictors would allow a better triage of patients who would benefit from its implantation.

Alternative technique of long acting cardioplegia delivery results in less hemodilution

Perfusion ◽  
2020 ◽  
pp. 026765912094672
Author(s):  
Geok Seen Ong ◽  
Goh Si Guim ◽  
Qi Xuan Lim ◽  
Huang Shoo Chay-Nancy ◽  
Nurdiyana Binte Jaafar ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Artery Bypass ◽  
Bypass Graft ◽  
University Hospital ◽  
Care Group ◽  
Alternative Technique ◽  
Safe Delivery ◽  
Delivery Technique ◽  
National University ◽  
Long Acting

Background: Preparation of del-Nido cardioplegia and its delivery technique can cause significant hemodilution. The resultant effects from hemodilution are largely proportionate to the use of a dual circuit. We opted for a custom-disposable single cardioplegia circuit instead of a dual circuit. Methods: We describe an alternative technique of del-Nido cardioplegia delivery and initial clinical experience with it at National University Hospital, Singapore. This is a retrospective analysis of data from January 2017 to April 2019, comprising of 177 patients of heart surgery and reflecting a single center database survey under the National Health Care Group. Results: Of the 177 patients who underwent surgery with del-Nido cardioplegia, 76 (42.9%) were valve-only procedures and 5 (2.8%) were coronary artery bypass graft–only procedures. Ultrafiltration was utilized in 132 (62.6%) patients, whereas filtrate volume was 2200 [150-9500] mL. The alternative technique of del-Nido cardioplegia delivery adopted by National University Hospital advocates for a single pump, single circuit system. The retrospective institutional data highlighted safe delivery of del-Nido cardioplegia using this technique in a range of procedures. Conclusion: Besides the safe delivery of del-Nido cardioplegia, the National University Hospital Technique reduces hemodilution and provides other technical benefits including a steeper temperature gradient, modification of circuit configuration to deliver another cardioplegia while on bypass, as well as re-configuration of clamps to spike the base solution.

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