Cardiac Surgery
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2021 ◽  
Vol 9 (34) ◽  
pp. 10595-10603
Fang Tang ◽  
Jian-Min Yi ◽  
Hong-Yan Gong ◽  
Zi-Yun Lu ◽  
Jie Chen ◽  

10.2196/26597 ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. e26597
Anna M Chudyk ◽  
Sandra Ragheb ◽  
David Kent ◽  
Todd A Duhamel ◽  
Carole Hyra ◽  

Background Despite the importance of their perspectives, end users (eg, patients, caregivers) are not typically engaged by academic researchers in the development of mobile health (mHealth) apps for perioperative cardiac surgery settings. Objective The aim of this study was to describe a process for and the impact of patient engagement in the development of an mHealth app that supports patient and caregiver involvement with enhanced recovery protocols during the perioperative period of cardiac surgery. Methods Engagement occurred at the level of consultation and took the form of an advisory panel. Patients who underwent cardiac surgery (2017-2018) at St. Boniface Hospital (Winnipeg, Manitoba) and their caregivers were approached for participation. A qualitative exploration determined the impact of patient engagement on the development (ie, design and content) of the mHealth app. This included a description of (1) the key messages generated by the advisory panel, (2) how key messages were incorporated into the development of the mHealth app, and (3) feedback from the developers of the mHealth app about the key messages generated by the advisory panel. Results The advisory panel (N=10) generated 23 key messages to guide the development of the mHealth app. Key design-specific messages (n=7) centered around access, tracking, synchronization, and reminders. Key content-specific messages (n=16) centered around medical terms, professional roles, cardiac surgery procedures and recovery, educational videos, travel, nutrition, medications, resources, and physical activity. This information was directly incorporated into the design of the mHealth app as long as it was supported by the existing functionalities of the underlying platform. For example, the platform did not support the scheduling of reminders by users, identifying drug interactions, or synchronizing with other devices. The developers of the mHealth app noted that key messages resulted in the integration of a vast range and volume of information and resources instead of ones primarily focused on surgical information, content geared toward expectations management, and an expanded focus to include caregivers and other family members, so that these stakeholders may be directly included in the provision of information, allowing them to be better informed, prepare along with the patient, and be involved in recovery planning. Conclusions Patient engagement may facilitate the development of a detail-oriented and patient-centered mHealth app whose design and content are driven by the lived experiences of end users.

2021 ◽  
Vol 79 (11) ◽  
pp. 1280-1281
Radosław Gocoł ◽  
Jarosław Bis ◽  
Damian Hudziak ◽  
Łukasz Morkisz ◽  
Marek A Deja

Émilie Richer-Séguin ◽  
Christian Ayoub ◽  
Jean-Sébastien Lebon ◽  
Jennifer Cogan ◽  
Stéphanie Jarry ◽  

2021 ◽  
pp. 1-6
Asaad G. Beshish ◽  
Elizabeth B. Aronoff ◽  
Nikita Rao ◽  
Mohua Basu ◽  
Tawanda Zinyandu ◽  

Abstract Background: Advances in surgical techniques and post-operative management of children with CHD have significantly lowered mortality rates. Unplanned cardiac interventions are a significant complication with implications on morbidity and mortality. Methods: We conducted a single-centre retrospective case–control study for patients (<18 years) undergoing cardiac surgery for repair of Tetralogy of Fallot between January 2009 and December 2019. Data included patient characteristics, operative variables and outcomes. This study aimed to assess the incidence and risk factors for reintervention of Tetralogy of Fallot after cardiac surgery. The secondary outcome was to examine the incidence of long-term morbidity and mortality in those who underwent unplanned reinterventions. Results: During the study period 29 patients (6.8%) underwent unplanned reintervention, and were matched to 58 patients by age, weight and sex. Median age was 146 days, and median weight was 5.8 kg. Operative mortality was 7%, and 1-year survival was 86% for the entire cohort (cases and controls). Hispanic patients were more likely to have reinterventions (p = 0.04) in the unadjusted analysis, while Asian, Pacific Islander and Native American (p = 0.01) in the multi-variate analysis. Patients that underwent reintervention were more likely to have post-op arrhythmia, genetic syndromes and higher operative and 1-year mortality (p < 0.05). Conclusion: Unplanned cardiac interventions following Tetralogy of Fallot repair are common, and associated with increased operative, and 1-year mortality. Race, genetic syndromes and post-operative arrhythmia are associated with increased odds of unplanned reinterventions. Future studies are needed to identify modifiable risk factors to minimise unplanned reinterventions.

2021 ◽  
Vol 69 (1) ◽  
Sameh R. Ismail ◽  
Akhter Mehmood ◽  
Noura Rabiah ◽  
Riyadh M. Abu-sulaiman ◽  
Mohamed S. Kabbani

Abstract Background Children with congenital heart disease (CHD) frequently become malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, and fluid restriction as part of the hemodynamic intervention. The abnormal nutritional status may affect early outcome after pediatric cardiac surgery; we aim to prove the importance of nutritional assessment and patient nutritional preparation before performing pediatric cardiac surgery. Results We conducted a prospective observational cohort study from March 2013 till January 2015. All children from birth until 14 years of age admitted to the pediatric cardiac intensive care unit (PCICU) after cardiac surgery. Nutritional status was assessed preoperatively and prognostic nutritional index (PNI) was calculated. All post-operative outcome parameters, PCICU and hospital length of stay (LOS), ventilation time, the rate of infection, and ICU mortality were recorded. Two hundred fifty-nine children were evaluated. At admission, 179 patients (69%) had intake less than 50% of the recommended daily allowance (RDA) of calories intake. There was a statistically significant relationship between pre-admission RDA and the infection rate (P value 0.018). Severely malnourished patients had significantly longer ICU length of stay (LOS) (P value = 0.049). Similarly, weight and height percentiles have a significant effect on ICU LOS (P value 0.009 and 0.045) respectively. There was a significant relation between PNI ≥ 55 and the ICU LOS (P < 0.05), and ventilation time (P = 0.036). Delay in feeding postoperatively was associated with a higher risk of infection (P = 0.005), and higher mortality (P = 0.03). Conclusions Children with CHD were significantly malnourished preoperatively and had further weight loss postoperatively. Preoperative nutritional status and delayed postoperative enteral feeding were associated with a higher infection rate and mortality.

Ali Eshraghi ◽  
Faeze Keihanian

Heparin-induced thrombocytopenia (HIT) is an immunogenic disorder. It can lead to thrombocytopenia and a hypercoagulated state with an increased risk for new thrombosis. We here reported a 49-year-old man with previous cardiac surgery and heparin administration, treated by new oral anticoagulant agent, Rivaroxaban.

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2229
Ah Ran Oh ◽  
Jungchan Park ◽  
Sooyeon Lee ◽  
Kwangmo Yang ◽  
Jin-Ho Choi ◽  

Elevated cardiac troponin (cTn) showed associations with mortality even in stable patients, but management has not been established. We aimed to investigate whether consultation to cardiologists could reduce mortality of stable patients with cTn elevation at admission. We identified 1329 patients with elevated cTn level at hospitalization from outpatient clinic to any department other than cardiology or cardiac surgery between April 2010 and December 2018. The patients were divided into two groups according to cardiologist consultation at admission. For primary outcome, mortality during one year was compared in the crude and propensity-score-matched populations. In 1329 patients, 397 (29.9%) were consulted to cardiologists and 932 (70.1%) were not. Mortality during the first year was significantly lower in patients consulted to cardiologists compared with those who were not (9.8% vs. 14.2%; hazard ratio (HR), 0.50; 95% confidence interval (CI), 0.35–0.72; p < 0.001). After propensity-score matching, 324 patients were in the cardiologist consultation group and 560 patients were in the no cardiologist consultation group. One-year mortality was consistently lower in the cardiologist consultation group (10.5% vs. 14.6%; HR, 0.58; 95% CI, 0.39–0.86; p = 0.01). Cardiologist consultation may be associated with lower mortality in stable patients with cTn elevation at admission. Further studies are needed to identify effective management strategies for stable patients with elevated cTn.

2022 ◽  
Vol 77 ◽  
pp. 110596
Teresa Pérez ◽  
Angel M. Candela-Toha ◽  
Loubna Khalifi ◽  
Alfonso Muriel ◽  
M. Carmen Pardo

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