scholarly journals Innovation and Research in Cardiac Surgery: Bioethical Aspects

2021 ◽  
Author(s):  
Andrea Montalto ◽  
Francesco Musumeci
Keyword(s):  
Cardiac Surgery ◽  
Surgical Procedures ◽  
Ethical Dilemmas ◽  
Scientific Research ◽  
Cardiac Surgical Procedures ◽  
Technological Evolution ◽  
Surgical Results ◽  
Patient Relationship ◽  
Moral Problems ◽  
Innovative Techniques

Significant advancements have been made in Cardiac surgery during the last decades, thanks to technological evolution. The enormous progress achieved has led to a relevant improvement in terms of surgical results, and at the same time, new ethical dilemmas have been addressed. Until the 90’s ethics in cardiac surgery mainly concerned significant moral problems caused by the introduction of extremely innovative techniques. However, today’s ethical issue focuses essentially on the doctor-patient relationship, other aspects of doctor’s practice concern relevant ethical perspectives. Ethics affects today the activity of the surgeon and the doctor in general. It is possible to distinguish clinical ethics, an ethics of health policies, and scientific research ethics. In the following chapter, we try to analyze the main ethical aspects concerning the application of cardiac surgical procedures.

scholarly journals Successful Triple Valve Surgery in an Undernourished Patient: What to Prepare?

2021 ◽  
Vol 5 (2) ◽  
Author(s):  
Dian Paramita Kartikasari ◽  
Esti Hindariati
Keyword(s):  
Cardiac Surgery ◽  
Heart Disease ◽  
Surgical Procedures ◽  
Valvular Heart Disease ◽  
Nutritional Assessment ◽  
Cardiac Surgical Procedures ◽  
The United States ◽  
Organ Injury ◽  
Individual Risk ◽  
Operative Outcomes

ABSTRACT  Valvular heart disease accountsfor 10% to 20% of all cardiac surgical procedures in the United States. The decision to intervene, as well as the type of intervention for a patient with severe valvular heart disease, should be based on an individual risk-benefit analysis. Once a patient is considered a candidate for cardiac surgery, a comprehensive patient evaluation of medical conditions and comorbidities helps improve operative outcomes and minimize the mortality rate. Patients with severe valvular heart disease with chronic heart failure at times, progressing to malnutrition. Patients undergoing cardiac surgery experience a systemic inflammatory response, which contributes to acute organ injury leading to a higher incidence of comorbidities and worse malnutrition. Therefore, preoperative risk and nutritional assessment are critical in performing safe cardiac surgical procedures. We report a case of a malnourished 17-year-old man with multiple valvular heart disease with optimal preparation, including good nutritional status leading to good outcome of complex cardiac surgery even in the high risk patients. Keywords             : valvular heart disease, malnutrition, perioperative assessmentCorrespondence   : [email protected]

Modular minimally invasive extracorporeal circulation ensures perfusion safety and technical feasibility in cardiac surgery; a systematic review of the literature

Perfusion ◽  
2021 ◽  
pp. 026765912110265
Author(s):  
Kyriakos Anastasiadis ◽  
Polychronis Antonitsis ◽  
Christos Asteriou ◽  
Apostolos Deliopoulos ◽  
Helena Argiriadou
Keyword(s):  
Systematic Review ◽  
Cardiac Surgery ◽  
Surgical Procedures ◽  
Closed System ◽  
Cardiac Surgical Procedures ◽  
Open Circuit ◽  
Acute Type ◽  
Review Of The Literature ◽  
Technical Feasibility ◽  
Volume Management

Introduction: Despite extensive evidence that shows clinical of superiority of MiECC, worldwide penetration remains low due to concerns regarding air handling and volume management in the context of a closed system. The purpose of this study is to thoroughly investigate perfusion safety and technical feasibility of performing all cardiac surgical procedures with modular (hybrid) MiECC, as experienced from the perfusionist’s perspective. Methods: We retrospectively reviewed perfusion charts of consecutive adult patients undergoing all types of elective, urgent, and emergency cardiac surgery under modular MiECC. The primary outcome measure was perfusion safety and technical feasibility, as evidenced in the need for conversion from a closed to an open circuit. A systematic review of the literature was conducted aiming to ultimately clarify whether there are any safety issues regarding MiECC technology. Results: We challenged modular MiECC use in a series of 403 consecutive patients of whom a significant proportion (111/403; 28%) underwent complex surgery including reoperations (4%), emergency repair of acute type A aortic dissection and composite aortic surgery (1.7%). Technical success rate was 100%. Conversion to an open circuit was required in 18/396 patients (4.5%), excluding procedures performed under circulatory arrest. Open configuration accounted for 40% ± 21% of total procedural perfusion time and was related to significant hemodilution and increase in peak lactate levels. Systematic review revealed that safety of the procedure challenged originated from a single report, while no clinical adverse event related to MiECC was identified. Conclusions: Use of modular MiECC secures safety and ensures technical feasibility in all cardiac surgical procedures. It represents a type III active closed system, while its stand-by component is reserved for a small (<5%) proportion of procedures and for a partial procedural time. Thus, it eliminates any safety concern regarding air handling and volume management, while it overcomes any unexpected intraoperative scenario.

Cardiac surgery

2020 ◽  
pp. 183-216
Keyword(s):  
Cardiac Surgery ◽  
Heart Valve ◽  
Surgical Procedures ◽  
Heart Defects ◽  
Artery Bypass ◽  
Cardiac Surgical Procedures ◽  
Healthcare Team ◽  
Off Pump ◽  
The Uk ◽  
Aneurysm Repair

This chapter covers the care of patients who require cardiac surgery, from placement on the waiting list to discharge. Although this involves the whole healthcare team, the focus of the chapter will be on the role of the nurse. The most common cardiac surgical procedures in the UK are coronary artery bypass grafting (CABG), with >16 000 operations performed each year, and heart valve surgery, with 78 000 heart valve operations each year. Other surgical procedures that nurses may come across include surgery for atrial fibrillation (AF), cardiomyopathy, aortic dissection, aneurysm repair, heart transplantation, and congenital heart defects. The principles of care for some of these operations are similar, so they will be discussed at the same time; where there are differences, these will be clarified. In the UK, CABG has been performed for >50yrs. During this time, some techniques have changed and now minimally invasive surgery and ‘off-pump’ surgery are more common. Changes in techniques for valve repair or replacement have meant that those previously at high risk for open heart valve replacement now have other options open to them.

Aortic Assessment for Cardiac Surgical Procedures

2006 ◽  
Vol 10 (2) ◽  
pp. 158-161 ◽  
Author(s):  
Daniel Bainbridge
Keyword(s):  
Cardiac Surgery ◽  
Transesophageal Echocardiography ◽  
Medical Therapy ◽  
Surgical Procedures ◽  
Heart Surgery ◽  
Surgical Techniques ◽  
Cardiac Surgical Procedures ◽  
Collagen Fibers ◽  
Review Of The Literature ◽  
Perioperative Mortality

Aortic atheromatous disease is associated with stroke in both the ambulatory and perioperative setting. In addition to atheromatous deposits, a reduction in the compliance of the aorta takes place as elastin fibers are replaced by collagen fibers. Both of these distinct processes, termed atherosclerosis, can easily be measured using transesophageal echocardiography during cardiac surgery. A review of the literature demonstrates many studies supporting the benefit of transesophageal echocardiography examination of the aorta for reducing stroke following cardiac surgery, through modification of surgical techniques. There have also been attempts by surgeons to remove atheromatous lesions from the aorta during cardiac surgery. Unfortunately, these procedures currently have a high perioperative mortality. Finally, medical therapy such as warfarin or statins may help reduce the incidence of stroke following heart surgery.

Changing practice patterns for children with heart disease: a clinical pathway approach

1998 ◽  
Vol 7 (2) ◽  
pp. 101-105 ◽  
Author(s):  
K Uzark ◽  
C Frederick ◽  
JJ Lamberti ◽  
HM Worthen ◽  
MT Ogino ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Length Of Stay ◽  
Ventricular Septal Defect ◽  
Tetralogy Of Fallot ◽  
Surgical Procedures ◽  
Clinical Pathway ◽  
Septal Defect ◽  
Practice Patterns ◽  
Clinical Pathways ◽  
Cardiac Surgical Procedures

BACKGROUND: Pediatric cardiac care is costly and requires extensive resources. We studied the effect of clinical pathways on practice patterns and patient care outcomes in infants and children hospitalized for cardiac surgery. METHODS: In consecutive patients admitted for selected cardiac surgical procedures before (n = 69) and after (n = 173) implementation of clinical pathways, outcomes including hospital length of stay, days in the ICU, time to extubation, ordering of blood studies, costs, and readmissions were compared. Data were analyzed for each of five cardiac surgical procedures: repair of an atrial septal defect, repair of a ventricular septal defect, division of a patent ductus arteriosus, repair of tetralogy of Fallot, and neonatal arterial switch operation to correct transposition of the great arteries. RESULTS: A significant reduction in length of hospital stay, including days in the ICU (decreased 1 to 2 days per admission), was achieved after the clinical pathway was implemented. Reductions in average duration of mechanical ventilation ranged from 28% for repair of a ventricular septal defect to 63% for repair of tetralogy of Fallot. The number of blood studies ordered decreased 20% to 30%. A significant reduction in hospital costs for each procedure, ranging from 16% to 29%, was also achieved with no adverse effects on patients' outcomes. CONCLUSIONS: Use of clinical pathways with children hospitalized for cardiac surgery can shorten length of stay in the hospital, reduce use of resources, and improve cost-effectiveness with beneficial outcomes for patients.

The Use of an Absorbable Microporous Polysaccharide Hemosphere Haemostat (AristaAH®) in Ventricular Assist Device Implant and Cardiac Transplantation Procedures

2012 ◽  
Vol 8 (2) ◽  
pp. 125
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe ◽  
◽  
Keyword(s):  
Surgical Procedures ◽  
Ventricular Assist Device ◽  
Cardiac Transplantation ◽  
Cardiac Surgical Procedures ◽  
High Risk Group ◽  
Cardiac Transplant ◽  
Assist Device ◽  
Ventricular Assist ◽  
Refractory Heart Failure ◽  
Haemostatic Agents

Topical haemostatic agents are useful adjuncts for the overall approach to haemostasis during mechanical support and cardiac transplant surgical procedures. Increasing numbers of cardiac surgical patients are presenting with pharmacologically induced impairment of the clotting cascade. Additionally, there continues to be an increase in the numbers of ventricular assist device implantations worldwide and these patients have haemostasis challenges both at the time of implantation and at subsequent transplantation. Patients undergoing assist device placement or cardiac transplantation usually have severe, refractory heart failure and varying degrees of multi-organ dysfunction, which make them susceptible to bleeding during the surgical procedure. Despite routine blood conservation measures and the use of intravenous agents, local surgical field haemostasis still remains a challenge. Topical agents are increasingly used in cardiac surgical procedures, especially in assist device or transplant cases. Herein, we report our institutional approach to topical haemostasis in a high-risk group of patients undergoing assist device or cardiac transplant. AristaAH®, a novel polysaccharide topical haemostat, provides effective and safe control of challenging bleeding situations.

Microporous Polysaccharide Hemosphere Absorbable Hemostat (AristaAH®) in Re-Operative Cardiac Surgical Procedures

2012 ◽  
Vol 9 (2) ◽  
pp. 96-98
Author(s):  
Brian A Bruckner ◽  
Matthias Loebe
Keyword(s):  
Patient Outcomes ◽  
Surgical Procedures ◽  
Systematic Approach ◽  
Surgical Intervention ◽  
Transfusion Requirement ◽  
Cardiac Surgical Procedures ◽  
Platelet Inhibitors ◽  
Hemostatic Agents ◽  
Surgical Field ◽  
Improve Patient

Patients undergoing re-operative cardiac surgical procedures present a great challenge with regard to obtaining hemostasis in the surgical field. Adhesions are ever-present and these patients are often on oral anti-coagulants and platelet inhibitors. As part of a well-planned surgical intervention, a systematic approach to hemostasis should be employed to decrease blood transfusion requirement and improve patient outcomes. Topical hemostatic agents can be a great help to the surgeon in achieving surgical field hemostasis and are increasingly being employed. Our approach, to these difficult patients, includes the systematic and planned use of AristaAH, which is a novel hemostatic agent whose use has proven safe and efficacious in our patient population.

scholarly journals Understanding the Barrier and Mechanical Behavior of Different Nanofillers in Chitosan Films for Food Packaging

Polymers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 721 ◽  
Author(s):  
João Pires ◽  
Camila Damásio de Paula ◽  
Victor Gomes Lauriano Souza ◽  
Ana Luísa Fernando ◽  
Isabel Coelhoso
Keyword(s):  
Mechanical Properties ◽  
Mechanical Behavior ◽  
Food Packaging ◽  
Scientific Research ◽  
Barrier Properties ◽  
Plastic Pollution ◽  
Functional Attributes ◽  
Chitosan Films ◽  
Commercial Applications ◽  
Innovative Techniques

The continuous petroleum-based plastics manufacturing generates disposal issues, spreading the problem of plastic pollution and its rise in the environment. Recently, innovative techniques and scientific research promoted biopolymers as the primary alternative for traditional plastics, raising and expanding global bioplastic production. Due to its unmatched biological and functional attributes, chitosan (Ch) has been substantially explored and employed as a biopolymeric matrix. Nevertheless, the hydrophilicity and the weak mechanical properties associated with this biopolymer represent a significant intrinsic restriction to its implementation into some commercial applications, namely, in food packaging industries. Distinct methodologies have been utilized to upgrade the mechanical and barrier properties of Ch, such as using organic or inorganic nanofillers, crosslinkers, or blends with other polymers. This review intends to analyze the most recent works that combine the action of different nanoparticle types with Ch films to reinforce their mechanical and barrier properties.

Volatile anaesthetics added to cardiopulmonary bypass are associated with reduced cardiac troponin

Perfusion ◽  
2017 ◽  
Vol 32 (7) ◽  
pp. 547-553 ◽  
Author(s):  
Elena Bignami ◽  
Marcello Guarnieri ◽  
Marina Pieri ◽  
Francesco De Simone ◽  
Alcira Rodriguez ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Troponin ◽  
Troponin I ◽  
Myocardial Necrosis ◽  
Perioperative Period ◽  
Cardiac Surgical Procedures ◽  
Control Group ◽  
Volatile Anaesthetics ◽  
Volatile Agents

Background: Every year, over 1 million cardiac surgical procedures are performed all over the world. Reducing myocardial necrosis could have strong implications in postoperative clinical outcomes. Volatile anaesthetics have cardiac protective properties in the perioperative period of cardiac surgery. However, little data exists on the administration of volatile agents during cardiopulmonary bypass. The aim of this study was to assess if volatile anaesthetics administration during cardiopulmonary bypass reduces cardiac troponin release after cardiac surgery. Materials and methods: We retrospectively analysed data from 942 patients who underwent cardiac surgery in a teaching hospital. The only difference between the groups was the management of anaesthesia during CPB. The volatile group received sevoflurane or desflurane while the control group received a combination of propofol infusion and fentanyl boluses. Patients who received volatile anaesthetics during cardiopulmonary bypass (n=314) were propensity-matched 1:2 with patients who did not receive volatile anaesthetics during CPB (n=628). Results: We found a reduction in peak postoperative troponin I, from 7.8 ng/ml (4.8-13.1) in the non-volatile group to 6.8 ng/ml (3.7-11.8) in the volatile group (p=0.013), with no differences in mortality [2 (0.6%) in the volatile group and 2 (0.3%) in the non-volatile group (p=0.6)]. Conclusions: Adding volatile anaesthetics during cardiopulmonary bypass was associated with reduced peak postoperative troponin levels. Larger studies are required to confirm our data and to assess the effect of volatile agents on survival.

Common cardiac surgical procedures: bypass, valve repair and replacement

2021 ◽  
Vol 39 (3) ◽  
pp. 156-163
Author(s):  
Kathrin Freystaetter ◽  
Enoch Akowuah
Keyword(s):  
Surgical Procedures ◽  
Cardiac Surgical Procedures ◽  
Valve Repair ◽  
Bypass Valve
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