Recent Views About Management of Pregnancy Following Previous Cardiac Surgery and Cardiac Transplant

Objective: We determined geographic access to transcatheter aortic valve replacement (TAVR) in Michigan, and compared it to the access of other invasive cardiac services; namely, percutaneous coronary intervention (PCI), non-transplant cardiac surgery, and cardiac transplant surgery. Methods: A geographic information systems analysis was performed using the 2010 U.S. Census Survey and hospital data from the state of Michigan to construct maps of service areas around hospitals providing TAVR, PCI, non-transplant cardiac surgery, and cardiac transplant surgery. Hospital service areas ranging from 5-miles to 75-miles driving distance were included in the analysis. Geographic access was calculated as the percentage of the population living within the hospital service areas providing the four types of cardiac procedures studied in this analysis. Results: A total of 15 hospitals provide TAVR in Michigan in 2015. For TAVR clinical sites, the mean number of beds, total annual discharges, and total annual patient days are 571, 28,946, and 140,859, respectively. Of the 9,883,640 persons in Michigan, 2,365,783 (23.9%) live within 5 miles, 7,856,455 (79.5%) live within 30 miles, and 9,004,943 (91.1%) live within 50 miles driving distance of a hospital offering TAVR. In general, these proportions mirror those for PCI (8,857,148 [89.6%] living within 30 miles) and non-transplant cardiac surgery (8,814,143 [89.2%] living within 30 miles), as opposed to cardiac transplant surgery (5,481,122 [55.5%] living within 30 miles) (Figure). Conclusions: Nearly 4 of 5 Michigan residents live within 30 miles driving distance of a hospital providing TAVR. Relative to other invasive cardiac services, TAVR is more similar in geographic access to PCI and non-transplant cardiac surgery than it is to cardiac transplant surgery. These findings may have implications for whether TAVR remains a highly specialized procedure or becomes a more broadly available option for aortic stenosis.

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Optimizing Surgical Skills in Cardiac Surgery Residents with Cardiac Transplant in the High-Fidelity Porcine Model

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519828016 ◽

2019 ◽

Vol 14 (1) ◽

pp. 37-42

Author(s):

Aaron J. Spooner ◽

Christina M. Faulkner ◽

Richard J. Novick ◽

William D. T. Kent

Keyword(s):

Cardiac Surgery ◽

Skill Acquisition ◽

Cardiac Transplantation ◽

Qualitative Interviews ◽

Cost Effective ◽

Surgical Skills ◽

Preclinical Model ◽

Cardiac Transplant ◽

Team Approach ◽

High Fidelity

Objectives Simulation is a pivotal tool within cardiac surgery to facilitate learner growth and skill acquisition. There are many methods of simulation and it is possible to develop and implement new curricula incorporating these modalities. The objective of this paper is to describe the feasibility of a high-fidelity cardiac transplant simulation curriculum for surgical residents. Methods Our simulation setting was the Animal Resource Center at the University of Calgary. It was set up with 4 separate operating rooms, 2 for donor heart retrievals and 2 for heart implantations. This was done to allow 2 learners to participate with each animal, replicating the true intraoperative environment. Our teaching sessions were facilitated by 2 surgeons experienced in cardiac transplantation. In addition, we had support staff including multiple perfusionists, nurses, and anesthesia technologists. Results The curriculum was evaluated from many perspectives in real time throughout the simulation as well as afterward in posttest qualitative interviews with all participants. The residents readily identified the acquisition of and increased proficiency in specifically targeted surgical skills. In addition, the residents were able to practice communication, collaboration, and management. Furthermore, the simulation session and our debriefings contributed significantly to fostering a team approach. Conclusions The pig is an excellent preclinical model for acquiring and developing the skills necessary for human cardiac transplantation. The residents partaking in the curriculum were satisfied with the learning they received and saw value in the swine transplant curriculum. The overall curriculum was cost-effective, due to the low overall operating costs associated with it.

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Anaesthesia for non-cardiac surgery in the post-cardiac transplant patient

Irish Journal of Medical Science (1971 -) ◽

10.1007/bf02973279 ◽

1995 ◽

Vol 164 (2) ◽

pp. 132-135 ◽

Cited By ~ 5

Author(s):

J. B. Lyons ◽

F. A. Chambers ◽

R. MacSullivan ◽

D. C. Moriarty

Keyword(s):

Cardiac Surgery ◽

Transplant Patient ◽

Cardiac Transplant ◽

Cardiac Transplant Patient

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Outcomes of Emergency Gastrointestinal Surgery Done on Post-Cardiac Surgery Patients—Analysis From a Tertiary Care Center

Surgical Technology Online ◽

10.52198/21.sti.39.gs1521 ◽

2021 ◽

Vol 39 ◽

Author(s):

Shekhar Gogna ◽

◽

Abbas Smiley ◽

Katherine French ◽

Syian Srikumar ◽

...

Keyword(s):

Cardiac Surgery ◽

Respiratory Failure ◽

Valve Replacement ◽

Serum Proteins ◽

Bypass Graft ◽

Tertiary Care ◽

Similar Proportion ◽

Cardiac Transplant ◽

Rehabilitation Center ◽

Acute Rehabilitation

Introduction: Abdominal complications following cardiac surgery have high mortality rates. This study analyzes the outcomes of patients who have undergone emergency general surgery (EGS) procedures after cardiothoracic surgery (CTS) at the same hospitalization. Materials and Methods: This was a retrospective analysis of all patients who underwent emergent abdominal surgery after CTS surgery between 2010–2018. The CTS procedures included coronary artery bypass graft (CABG), valve replacement, cardiac transplant, aortic replacement, ventricular assist device, and pericardial procedures. The records were reviewed to obtain demographics, frequency distribution of EGS procedures, complications, outcomes, and the risk factors of mortality. Results: Of 4826 patients who had CTS, 57 (1.2%) underwent EGS procedures during the period of 2010–2018. This cohort of patients had 113 CTS and 85 EGS procedures during the same hospitalization. The mean age was 62 years, and 49% were elderly (40% were females). CABG with or without valve replacement was the most common surgery (28%). After surgical consultation for “acute abdomen” in the post-CTS phase, the three most common findings on exploratory laparotomy were bowel perforation (23%), massive free fluid leading to abdominal compartment syndrome (19%), and acute cholecystitis (16%). Respiratory failure (46%), acute kidney injury (32%), and multiple organ dysfunction (18%) were the most common hospital-acquired complications. Regarding dispositions, 47% were discharged to an acute rehabilitation center, 10% were discharged to a sub-acute rehabilitation center, and a similar proportion of patients went home (10%). On multivariable logistic regression analysis with backward elimination, age (OR=1.10, 95% CI: 1.02–1.18) and serum proteins (OR=0.99, 95% CI: 0.98-0.998) were independently associated with the odds of mortality after EGS in the immediate CTS phase. Conclusions: Respiratory failure is the most common complication of EGS immediately after CTS. The older the patient and the lower the serum proteins, the higher the odds of mortality in patients who undergo EGS after ETS.

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The Experience of Cardiac Surgery and Cardiac Transplant

Modern Perspectives in the Psychiatric Aspects of Surgery ◽

10.1007/978-1-349-04046-9_12 ◽

1976 ◽

pp. 243-266 ◽

Cited By ~ 6

Author(s):

Chase Patterson Kimball

Keyword(s):

Cardiac Surgery ◽

Cardiac Transplant

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Anaesthesia for non-cardiac surgery in a cardiac transplant recipient

Indian Journal of Anaesthesia ◽

10.4103/0019-5049.84849 ◽

2011 ◽

Vol 55 (4) ◽

pp. 405 ◽

Cited By ~ 10

Author(s):

Amit Kumar ◽

Sneh Lata ◽

AdarshC Swami ◽

Sunny Rupal

Keyword(s):

Cardiac Surgery ◽

Transplant Recipient ◽

Cardiac Transplant ◽

Cardiac Transplant Recipient

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Multidrug Resistant Pseudomonas Mycotic Pseudoaneurysm following Cardiac Transplant Bridged by Ventricular Assistant Device

Case Reports in Infectious Diseases ◽

10.1155/2017/1402320 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

C. Aye ◽

M. Williams ◽

R. Horvath

Keyword(s):

Pseudomonas Aeruginosa ◽

Cardiac Surgery ◽

Cardiac Transplantation ◽

Multimodality Treatment ◽

Multidrug Resistant ◽

Left Ventricular ◽

Ascending Aorta ◽

Cardiac Transplant ◽

Bridging Therapy ◽

Mycotic Pseudoaneurysm

Mycotic pseudoaneurysm of aorta following cardiac surgery is rare but is highly fatal if it is unrecognized and untreated. Here, we report a case of a 45-year-old male patient who presented with rapidly progressive multiple pseudoaneurysms of the ascending aorta infected with multidrug resistant (MDR) Pseudomonas aeruginosa at 5 weeks after cardiac transplantation, on a background of prior bridging therapy with left ventricular assistant device (LVAD). The patient was successfully treated with the newer cephalosporin, Ceftolozane/Tazobactam, in combination with surgery. This is the first reported case of mycotic pseudoaneurysm infected with MDR Pseudomonas. This case also highlights the importance of high vigilance and timely multimodality treatment in the diagnosis and management of mycotic pseudoaneurysm following cardiac transplant, especially in patients who had LVAD.

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