scholarly journals Cardiac Repair in Patients with Trisomy 18: Total or Palliative?

2021 ◽  
Vol 31 (2) ◽  
Author(s):  
Ji Hee Kwak ◽  
Jinyoung Song ◽  
I-Seok Kang ◽  
June Huh ◽  
Ji-Hyuk Yang ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Medical Records ◽  
Operative Mortality ◽  
Palliative Surgery ◽  
Cardiac Repair ◽  
Trisomy 18 ◽  
One Stage ◽  
Operative Outcomes ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit

Background: There are reports about cardiac surgery in patients with trisomy 18. However, total cardiac repair with bypass is limited in those patients. Objectives: We aimed to evaluate palliative cardiac surgery and compare it to total cardiac repair in patients with trisomy 18. Methods: Retrospectively, 11 patients’ medical records were reviewed. The patients were grouped as palliative surgery (3 patients), total repair followed by palliative surgery (6 patients), and one-stage total repair (2 patients). A total of 17 cardiac surgeries in all patients consisted of nine palliative surgeries and eight total cardiac repairs with bypass. The cumulative survival and post-operative outcomes including complications were investigated. Results: Eleven patients underwent 17 cardiac surgeries in total. Four patients survived, with a median age of 827.5 days. The survivors consisted of two after one-stage total repair and two after total repair followed by palliative surgery. No survivors were found after only palliative surgery. When post-operative outcomes after palliative surgery in nine patients were compared to those after total cardiac repair in eight patients, there were no differences in operative mortality, postoperative intensive care unit stay, and hospital stay. No differences in post-operative complications were found. Conclusions: For post-operative outcomes and survival, palliative surgery in patients with trisomy 18 was not different from total cardiac repair with bypass but involved a difficult postoperative course including various complications similar to those after total repair with bypass.

Predictors of Operative Mortality in Cardiac Surgery Patients with Prolonged Ventilation

2018 ◽  
Vol 227 (4) ◽  
pp. e97-e98
Author(s):  
Alejandro Suarez-Pierre ◽  
Charles D. Fraser ◽  
Xun Zhou ◽  
Cecillia Lui ◽  
Todd C. Crawford ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Operative Mortality ◽  
Prolonged Ventilation

Intensive Insulin Therapy in Postoperative Intensive Care Unit Patients

2006 ◽  
Vol 173 (4) ◽  
pp. 407-413 ◽  
Author(s):  
Moritoki Egi ◽  
Rinaldo Bellomo ◽  
Edward Stachowski ◽  
Craig J. French ◽  
Graeme Hart ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Insulin Therapy ◽  
Intensive Insulin Therapy ◽  
Postoperative Intensive Care ◽  
Postoperative Intensive Care Unit

scholarly journals Surgical Explantation of Transcatheter Aortic Valve Bioprostheses

2021 ◽  
Vol 14 (4) ◽  
Author(s):  
Alexander A. Brescia ◽  
G. Michael Deeb ◽  
Stephane Leung Wai Sang ◽  
Daizo Tanaka ◽  
P. Michael Grossman ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Aortic Valve ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Paravalvular Leak ◽  
Transcatheter Aortic Valve ◽  
Risk Of Mortality ◽  
Risk Patients ◽  
Transcatheter Valve ◽  
Predicted Risk

Background: Despite the rapid adoption of transcatheter aortic valve replacement (TAVR) since its initial approval in 2011, the frequency and outcomes of surgical explantation of TAVR devices (TAVR-explant) is poorly understood. Methods: Patients undergoing TAVR-explant between January 2012 and June 2020 at 33 hospitals in Michigan were identified in the Society of Thoracic Surgeons Database and linked to index TAVR data from the Transcatheter Valve Therapy Registry through a statewide quality collaborative. The primary outcome was operative mortality. Indications for TAVR-explant, contraindications to redo TAVR, operative data, and outcomes were collected from Society of Thoracic Surgeons and Transcatheter Valve Therapy databases. Baseline Society of Thoracic Surgeons Predicted Risk of Mortality was compared between index TAVR and TAVR-explant. Results: Twenty-four surgeons at 12 hospitals performed TAVR-explants in 46 patients (median age, 73). The frequency of TAVR-explant was 0.4%, and the number of explants increased annually. Median time to TAVR-explant was 139 days and among known device types explanted, most were self-expanding valves (29/41, 71%). Common indications for TAVR-explant were procedure-related failure (35%), paravalvular leak (28%), and need for other cardiac surgery (26%). Contraindications to redo TAVR included need for other cardiac surgery (28%), unsuitable noncoronary anatomy (13%), coronary obstruction (11%), and endocarditis (11%). Overall, 65% (30/46) of patients underwent concomitant procedures, including aortic repair/replacement in 33% (n=15), mitral surgery in 22% (n=10), and coronary artery bypass grafting in 16% (n=7). The median Society of Thoracic Surgeons Predicted Risk of Mortality was 4.2% at index TAVR and 9.3% at TAVR-explant ( P =0.001). Operative mortality was 20% (9/46) and 76% (35/46) of patients had in-hospital complications. Of patients alive at discharge, 37% (17/37) were discharged home and overall 3-month survival was 73±14%. Conclusions: TAVR-explant is rare but increasing, and its clinical impact is substantial. As the utilization of TAVR expands into younger and lower-risk patients, providers should consider the potential for future TAVR-explant during selection of an initial valve strategy.

scholarly journals Clinical Course of 16 Patients with Trisomy 18 Who Underwent Cardiac Surgery

2015 ◽  
Vol 31 (5) ◽  
pp. 254-264
Author(s):  
Eiji Ehara ◽  
Yosuke Murakami ◽  
Kae Nakamura ◽  
Takeshi Sasaki ◽  
Mitsuhiro Fujino ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Clinical Course ◽  
Trisomy 18

Abstract 355: Relationship between Female Gender and Mortality after Isolated Aortic Valve Replacement

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Xiumei Sun ◽  
Jennifer Ellis ◽  
Louis Kanda ◽  
Robert Lowery ◽  
Steven W Boyce ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Coronary Artery Bypass Surgery ◽  
Operative Mortality ◽  
Artery Bypass ◽  
Female Gender ◽  
Operative Outcomes ◽  
Study Population

Background: Previous studies have shown that female gender is an independent predictor of increased operative mortality after coronary artery bypass surgery. It remains inconsistent whether female gender is associated with increased mortality after aortic valve replacement (AVR). The purpose of this study is to investigate the role of female gender inoperative mortality after AVR. Methods: The study population included isolated AVR performed between January 2003 and December 2012 at a single Instituation. Results: During this period, 1,262 patients underwent isolated AVR. The major preoperative characteristics and operative outcomes are detailed in the following table. R>Conclusions: In this study, female patients had increased operative mortality after isolated AVR.

scholarly journals Pilot of an International Collaboration to Build Capacity to Provide Gynecologic Oncology Surgery in Botswana

2018 ◽  
Vol 28 (9) ◽  
pp. 1807-1811 ◽  
Author(s):  
Rebecca Luckett ◽  
Kitenge Kalenga ◽  
Fong Liu ◽  
Katharine Esselen ◽  
Chris Awtrey ◽  
...  
Keyword(s):  
Gynecologic Oncology ◽  
Gynecologic Malignancies ◽  
Postoperative Intensive Care ◽  
Multidisciplinary Clinic ◽  
Local Capacity ◽  
Cervical Disease ◽  
Obstetric Emergencies ◽  
Oncology Treatment ◽  
Postoperative Intensive Care Unit

ObjectivesGynecologic malignancies are the leading cause of cancer death among women in Botswana. Twenty-five percent of cervical cancers present at a stage that could be surgically cured; however, there are no gynecologic oncologists to provide radical surgeries. A sustainable model for delivery of advanced surgery is essential to advance treatment for gynecologic malignancies.Methods/MaterialsA model was developed to provide gynecologic oncology surgery in Botswana, delivered by US-based gynecologic oncologists in four 2-week blocks per year. A pilot gynecologic oncology campaign was planned at a district hospital. Eligible patients were identified through the gynecologic oncology multidisciplinary clinic at the regional referral hospital, where gynecologic oncology treatment planning is provided. Local providers were invited to participate to build local surgical capacity.ResultsOne US-based gynecologic oncologist, 2 gynecologists, and 2 surgeons working in Botswana participated in the pilot campaign. Sixteen operations were performed over 7 days. Indications included cervical cancer (4), ovarian cancer (3), vulvar cancer (1), complex atypical hyperplasia (1), pre-invasive cervical disease (2), and benign disease (3), as well as 2 obstetric emergencies. The only gynecologic oncology complication was a case of bleeding requiring transfusion and postoperative intensive care unit admission. Follow-up care was coordinated through the gynecologic oncology multidisciplinary clinic.ConclusionsPeriodic gynecologic oncology campaigns in settings otherwise lacking local capacity to perform advanced surgery are a feasible model to create access and build local capacity. Strong local collaboration is essential. Future strategies to increase impact include recruitment of more gynecologic oncologists to increase service and training availability.

Perioperative complications in a paediatric cardiac surgery program with limited systemic resources

2020 ◽  
Vol 30 (11) ◽  
pp. 1659-1665
Author(s):  
Igor V. Polivenok ◽  
William M. Novick ◽  
Aleksander V. Pyetkov ◽  
Marcelo Cardarelli
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Confidence Interval ◽  
Odds Ratio ◽  
Operative Mortality ◽  
Perioperative Complications ◽  
Failure To Rescue ◽  
Middle Income ◽  
Paediatric Cardiac Surgery ◽  
Complications Rate

AbstractBackground:The perioperative complications rate in paediatric cardiac surgery, as well as the failure-to-rescue impact, is less known in low- and middle-income countries.Aim:To evaluate perioperative complications rate, mortality related to complications, different patients’ demographics, and procedural risk factors for perioperative complication and post-operative death.Methods:Risk factors for perioperative complications and operative mortality were assessed in a retrospective single-centre study which included 296 consecutive children undergoing cardiac surgery.Results:Overall mortality was 5.7%. Seventy-three patients (24.7%) developed 145 perioperative complications and had 17 operative mortalities (23.3%). There was a strong association between the number of perioperative complications and mortality – 8.1% among patients with only 1 perioperative complication, 35.3% – with 2 perioperative complications, and 42.1% – with 3 or more perioperative complications (p = 0.007). Risk factors of perioperative complications were younger age (odds ratio 0.76; (95% confidence interval 0.61, 0.93), previous cardiac surgery (odds ratio 3.5; confidence interval 1.33, 9.20), extracardiac structural anomalies (odds ratio 3.03; confidence interval 1.27, 7.26), concomitant diseases (odds ratio 3.23; confidence interval 1.34, 7.72), and cardiopulmonary bypass (odds ratio 6.33; confidence interval 2.45, 16.4), whereas the total number of perioperative complications per patient was the only predictor of operative death (odds ratio 1.89; confidence interval 1.06, 3.37).Conclusions:In a program with limited systemic resources, failure-to-rescue is a major contributor to operative mortality in paediatric cardiac surgery. Despite the comparable crude mortality, the operative mortality among patients with perioperative complications in our series was significantly higher than in the developed world. A number of initiatives are needed in order to improve failure-to-rescue rates in low- and middle-income countries.

scholarly journals P774 Utility of global longitudinal strain to predict post-operative outcomes in non-cardiac surgery

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C J Park ◽  
L S Tan ◽  
P Huang ◽  
P J Tan ◽  
J H J See
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Surgery ◽  
Risk Stratification ◽  
Longitudinal Strain ◽  
Myocardial Injury ◽  
Global Longitudinal Strain ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Operative Outcomes ◽  
Lv Dysfunction

Abstract Background Pre-operative echocardiography is performed in selected groups of patients for cardiac risk stratification prior to surgery. Many parameters, including Left Ventricular Ejection Fraction (LVEF), are assessed during echocardiography. While many studies have cited association between low LVEF and poor operative outcomes such as perioperative myocardial infarction or cardiogenic pulmonary edema, LVEF has limitations such as left ventricular (LV) cavity border tracing, geometric assumptions and inter-observer variability. LVEF may also appear normal in the presence of LV hypertrophy and a small LV cavity size. Studies have described the routine use of global longitudinal strain (GLS) as an alternative measure of ventricular function, with GLS having been reported to be a reliable marker in detecting subclinical LV dysfunction. This adds incremental value in predicting myocardial function and in risk stratification. In fact, some studies have documented GLS being a useful preoperative parameter in predicting postoperative LV dysfunction after cardiac valve surgery. Purpose The aim of this study is to determine the value of GLS in predicting post-operative outcomes in patients undergoing non-cardiac surgeries. Methods This was a retrospective study of all patients who had echocardiography performed for a pre-operative indication from February 2017 to October 2017. These patients were screened for those who had normal LVEF, had undergone subsequent non-cardiac surgery, and had post-operative troponins measured. Medical records were traced for baseline demographics, past medical history and echocardiographic features. GLS evaluation was prospectively performed using TOMTEC-ARENA (TOMTEC Imaging Systems GmbH) by assessors blinded to patient outcomes. Outcomes for major adverse cardiovascular events and mortality up to 1 year post surgery were collected. Post-op myocardial injury was defined as a peak Troponin T value of >30 ng/L or a >20% increment from baseline. Results A total of 42 patients were included. 61.9% (n = 26) were male and mean age was 72.3 years. Only 75.6% of patients were fully independent with activities of daily living and mean creatinine was 153.4μmol/L. Mortality at 1 year was 16.7% (n = 7) and 28.6% (n = 12) were deemed to have post-operative myocardial injury. 1-year mortality was associated with a lower GLS (-23.8% vs -19.2%, p = 0.001). However, GLS was not correlated with post-operative myocardial injury or hospital readmissions. In our study population, only a history of past myocardial infarction predicted post-op myocardial injury (58.3% vs 16.7%, p = 0.019). Conclusion Our study did not demonstrate the utility of GLS in predicting post-operative events, but this is likely because of the small sample size with low event rates. Nevertheless, GLS values did correlate with 1-year mortality and could be a marker of frailty and an increased mortality risk.

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