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Resumen Objetivo: El objetivo del presente estudio es evaluar en nuestro medio la prevalencia de anemia en el preoperatorio de la cirugía cardiovascular, su incidencia postoperatoria y su evolución durante el primer mes. Métodos: Se realizó un estudio de cohorte prospectivo en el que se incluyeron todos los pacientes sometidos a cirugía cardiovascular central intervenidos durante el periodo del 01/09/2021 al 01/09/2022 en un hospital universitario. Se realizó seguimiento clínico y de laboratorio previo a la cirugía, al quinto y al día treinta del postoperatorio. Se comparó a los grupos con y sin anemia preoperatoria. Resultados: La prevalencia de anemia en el preoperatorio fue del 32.1%. La incidencia de anemia en el postoperatorio fue del 96% en el grupo de pacientes sin anemia previa. Al mes de la cirugía un 73 y un 90% de los pacientes, con y sin anemia preoperatoria respectivamente, persistían anémicos. Los pacientes con anemia preoperatoria tuvieron una menor recuperación de sus valores de hemoglobina al mes. Se observó una tendencia a mayor mortalidad y una mayor necesidad de derivación a centros de rehabilitación postegreso hospitalario en aquellos con anemia preoperatoria. Conclusiones: En este trabajo se evidenció una alta prevalencia e incidencia de anemia en el perioperatorio de las cirugías cardiovasculares. Así como su subtratamiento y elevada persistencia durante el mes posterior a la cirugía.
Abstract Objective: The aim of this study is to evaluate the prevalence of anemia in the preoperative period of cardiovascular surgery, its postoperative incidence and its evolution during the first month in our setting. Methods: A prospective cohort study was carried out in which all patients undergoing central cardiovascular surgery operated during the period 09/01/2021-09/01/2022 in a university hospital were included. Clinical and laboratory follow-up was carried out prior to surgery, on the fifth and on the 30th postoperative day. Groups with and without preoperative anemia were compared. Results: The prevalence of anemia in the preoperative period was 32.1%. The incidence of anemia in the postoperative period was 96% in the group of patients without previous anemia. One month after surgery, 73 and 90% of the patients, with and without preoperative anemia, respectively, remained anemic. Patients with preoperative anemia had less recovery of their hemoglobin values at one month. A trend towards higher mortality and a greater need for referral to post-hospital discharge rehabilitation centers was observed in those with preoperative anemia. Conclusions: In this work, a high prevalence and incidence of anemia in the perioperative period of cardiovascular surgeries was evidenced. As well as its subtreatment and high persistence during the month after surgery.
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Toda especialidad médica, y en especial las quirúrgicas, necesitan, de alguna manera, vislumbrar el futuro que puedan ofrecer a los miembros más jóvenes de la especialidad y eventuales interesados en esta, de manera de asegurarles las mejores posibilidades de desarrollo profesional y personal, para, a su vez, poder reclutar a los mejores. Empero, para imaginar y forjar el futuro, es necesario vivir y enfrentar el presente. Pero, todo presente se asienta en un pasado, que es necesario conocer y meditar. Y de esto trata este artículo especial: pasado, presente y futuro de la cirugía de corazón, desde la particular visión de su autor.
Every medical specialty, mainly surgical specialties, needs to envision the future they can offer to the specialty's younger members and those eventually interested in it to assure them of the best possibilities for professional and personal development and, in turn, to be able to recruit the best one. However, it is necessary to live and face the present to imagine and forge the future. But every present is based on a past, which must be known and meditated upon. This article is about the past, present, and future of heart surgery, according to the particular vision of its author.
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Objective To evaluate effectiveness of evidence-based nursing practice of postoperative delirium management during cardiac surgery under cardiopulmonary bypass.Methods The best evidence was selected for the prevention and management of delirium after cardiac surgery under cardiopulmonary bypass.From May 2022 to April 2023,the evidence-based nursing practice was developed and applied into the Department of Cardiovascular and Macro-vascular Surgery of a tertiary A general hospital in Wuhan.The nurses'knowledge,belief and practice of postoperative delirium,incidence of postoperative delirium and subdelirium syndrome,the implementation rate of examination indicators were compared before and after the application of evidence.Results A total of 27 articles were finally included.Based on this,23 pieces of the best evidence were selected,and 27 review indicators were constructed.Through evidence-based practice,the scores of nurses'knowledge,belief and practice questionnaire were significantly increased from(100.81±13.92)to(105.51±10.35)(P＜0.05).The implementation rate of 24 indicators was significantly higher compared with baseline review(P＜0.05).The incidence of delirium decreased from 43.5％ to 34.7％(P=0.120).The incidence of postoperative subdelirium syndrome decreased from 55.1％ to 40.1％(P=0.010).The duration of postoperative delirium and sub delirium significantly decreased,respectively(P＜0.05).Conclusion Evidence-based practice can reduce the incidence of subdelirium syndrome,and it can reduce postoperative delirium and the duration of subdelirium syndrome.It can improve nurses'knowledge and practice of postoperative delirium care.
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Along with clinical practice and education, research is among the most important activities for medical doctors. The same is true in cardiovascular surgery: Young cardiovascular surgeons are expected to improve their surgical techniques and prioritize their clinical practice. However, their perspective on the role of research in their field of expertise is unknown. Therefore, we conducted a survey of and discussion with young cardiovascular surgeons to clarify their thoughts and concerns about performing research. Here we review and report the survey and discussion results.
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Resumo Fundamento: O pós-operatório de cirurgia cardíaca valvar é desafiador devido ao risco de sangramento, levando a complicações e aumento da morbimortalidade. Objetivo: Desenvolver um escore de risco para prever hemorragia em pacientes no pós-operatório de cirurgia valvar. Métodos: Estudo retrospectivo de pacientes submetidos a cirurgia valvar entre 2021 e 2022 no IDPC. Pacientes com sangramento maior foram selecionados com base nos critérios de BARC e Bojar. Foi realizada uma análise de regressão logística para fatores relacionados ao sangramento e foi criado um nomograma. Para significância estatística, foram considerados p<0,05 e um intervalo de confiança de 95%. O estudo foi aprovado pelo CEP. Resultados: Foram analisados 525 pacientes com idade média de 56 anos e predomínio do sexo feminino. A valvopatia mais comum foi a insuficiência mitral, 8,8% apresentaram sangramento aumentado e houve 4,3% de reabordagens cirúrgicas. As variáveis com significância estatística foram: insuficiência tricúspide (OR 3,31, p < 0,001), doença renal crônica/lesão renal aguda (OR 2,97, p = 0,006), hemoglobina pré-operatória (OR 0,73, p < 0,001), reoperações (OR 2,5, p = 0,003), tempo de circulação extracorpórea (CEC) (OR 1,12, p < 0,001), abordagem de 2 valvas OR de 2,23 (p = 0,013), uso de concentrado de hemácias OR de 2,8 (p = 0,001). No modelo múltiplo a insuficiência tricúspide, tempo de CEC e hemoglobina pré-operatória alcançaram significância estatística. Conclusão: O tempo de CEC, hemoglobina pré-operatória e insuficiência tricúspide associaram-se independentemente com hemorragia pós-operatória. A escala proposta é plausível, e pode auxiliar na predição de risco de sangramento.
Abstract Background: The postoperative period of heart valve surgery is challenging due to the risk of bleeding, leading to complications and increased morbidity and mortality. Objective: To develop a risk score to predict bleeding in patients after valve surgery. Methods: Retrospective study of patients operated on between 2021 and 2022. Patients with major bleeding were selected based on the BARC and Bojar criteria. A logistic regression analysis was performed for factors related to bleeding and a nomogram of scores was created. For statistical significance, p<0.05 and a 95% confidence interval were considered. The study was approved by the CEP. Results: 525 patients were analyzed, with a mean age of 56 years and a predominance of females. The most common valve disease was mitral insufficiency, 8.8% had increased bleeding and 4.3% had surgical reoperations. The variables with statistical significance were tricuspid insufficiency (OR 3.31, p < 0.001), chronic kidney disease/acute kidney injury (OR 2.97, p = 0.006), preoperative hemoglobin (OR 0.73, p < 0.001), reoperations (OR 2, 5, p = 0.003), cardiopulmonary bypass (CPB) time (OR 1.12, p < 0.001), 2-valve approach OR of 2.23 (p = 0.013), use of packed red blood cells OR of 2.8 (p = 0.001). In the multiple model, tricuspid insufficiency, CPB time and preoperative hemoglobin reached statistical significance. Conclusion: CPB time, preoperative hemoglobin and tricuspid insufficiency were independently associated with postoperative bleeding. The proposed scale is plausible and can help predict the risk of bleeding.
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ABSTRACT Introduction: Cardiovascular surgery has undergone numerous changes over the last decades. Transcatheter technologies, endovascular procedures, hybrids, and minimally invasive surgery have undoubtedly advanced as a therapy for patients. Thus, the discussion about the training of residents in the face of new technologies in the specialty is in check. In this article, it is proposed a review to discuss the challenges in this scenario as well as the current training in cardiovascular surgery in Brazil. Methods: A comprehensive review was performed in the Brazilian Journal of Cardiovascular Surgery. All editions from 1986 to 2022 were included. The research was carried out using the search engine on the journal's website (https://www.bjcvs.org) and an individual analysis of the titles and abstracts of each article published. Results: All the studies are summarized in the appropriate table with a discussion along this review. Conclusion: Most articles that discuss training in cardiovascular surgery in the national context are editorials and expert points of view with no observational studies evaluating the residency programs.
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As part of U-40 activities, chapters have traditionally held sessions of lectures and hands-on as the Basic Lecture Course (BLC) to improve the basic skills and knowledge of young cardiovascular surgeons. Because of the COVID-19 epidemic, we have shifted our activities from onsite to online. This column focuses on “management of postoperative delirium and pain” in the lecture of “Postoperative Management in Cardiovascular Surgery” given by the Chubu Chapter in 2020. We summarize the lecture and report the results of a questionnaire survey of the U-40 members.
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The cardiovascular patch, served as artificial graft materials to replace heart or vascular tissue defect, is still playing a key role in cardiovascular surgeries. The defects of traditional cardiovascular patch materials may determine its unsatisfactory long-term effect or fatal complications after surgery. Recent studies on many new materials (such as tissue engineered materials, three-dimensional printed materials, etc) are being developed. Patch materials have been widely used in clinical procedures of cardiovascular surgeries such as angioplasty, cardiac atrioventricular wall or atrioventricular septum repair, and valve replacement. The clinical demand for better cardiovascular patch materials is still urgent. However, the cardiovascular patch materials need to adapt to normal coagulation mechanism and durability, promote short-term endothelialization after surgery, and inhibit long-term postoperative intimal hyperplasia, its research and development process is relatively complicated. Understanding the characteristics of various cardiovascular patch materials and their application in cardiovascular surgeries is important for the selection of new clinical surgical materials and the development of cardiovascular patch materials.
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Cardiac Surgical Procedures/methods , Tissue Engineering , Heart Ventricles , Heart Atria , Treatment OutcomeABSTRACT
@#Committee of Minimally Invasive Cardiovascular Surgery (CMICS) annually investigates the minimally invasive cardiovascular surgery performed by departments of cardiovascular surgery of all hospitals in China of last year, and makes classification and summary according to the operation amount of minimally invasive surgery, regional and hospital distribution, and publishes it on the theme report of China Minimally Invasive Cardiovascular Surgery Conference (CMC). In 2021, CMICS published the 2018-2019 annual data of Chinese cardiovascular surgery in the form of a white paper for the first time in the Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, which attracted great attention from peers. In this statistical report, CMICS will focus on the volume of minimally invasive cardiovascular surgery, regional and hospital distribution in China (excluding Hong Kong Special Administrative Region, Macao Special Administrative Region, and Taiwan Province) in the 2020—2021 for your reference.
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Thalassemia is an inherited hemoglobin disorder characterized by hemolytic anemia. Reportedly, cardiopulmonary bypass (CPB) causes hemolysis; therefore, extreme caution is warranted during CPB. However, few studies have reported open heart surgery in patients with thalassemia. We report successful surgery for aortic stenosis and regurgitation (ASR) and an ascending aortic aneurysm (AsAA) in a patient with thalassemia. A 69-year-old woman was referred to our hospital for surgical management of ASR and AsAA. Comprehensive evaluation of microcytic anemia led to diagnosis of beta-thalassemia minor. We performed aortic valve and ascending aorta replacement; we used a biologic valve and performed open distal anastomosis under hypothermic circulatory arrest (25°) combined with retrograde cerebral perfusion. Non-pulsatile flow circulation was maintained using a centrifugal pump during CPB. The suction and ventilatory pressures were decreased, and we performed dilutional ultrafiltration. A spare artificial lung was connected to the CPB to avoid complications in the event of artificial lung blockage. We did not observe any hemolysis-induced adverse event during the clinical course, and the patient was discharged 20 days postoperatively. Careful preoperative evaluation is essential to confirm thalassemia before cardiovascular surgery to establish an optimal surgical strategy and avoid the risk of CPB-induced hemolysis in patients with the hematological disorder.
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Lately, there has been a trend towards integration among cardiovascular surgery institutions. However, local institutions continue to play a crucial role in community-based medicine, given the emergent nature of cardiovascular diseases and the challenges involved in transporting patients with such conditions over long distances. We present the results of a questionnaire survey we conducted to examine the current status and issues faced by cardiovascular surgery institutions in community-based medicine.
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The first examination of the new board of the Japanese cardiovascular surgery took place in 2022. As it is a transitional period for the new system, many doctors are not familiar with the changes and details of the new system, and some have their concerns. Here, we held a round-table discussion with doctors who actually took the new board of the Japanese cardiovascular surgery under the new system, and we summarized their opinion.
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@#In 2022, many excellent clinical studies emerged in the field of cardiovascular surgery. Selecting papers published in The New England Journal of Medicine and other top medicine and cardiology journals, this review focused on the research progress on 7 topics in the field of cardiovascular surgery: coronary artery surgery, vascular surgery, valvular surgery, structural heart disease, congenital heart disease, heart transplantation, perioperative management, and special population.
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Introducción: Una intervención de enfermería durante la circulación extracorpórea en cirugía cardiovascular puede reducir la aparición de complicaciones, la estadía en unidad de cuidados intensivos, hospitalaria y la mortalidad. Se ofrecen cuidados articulando los dominios de atención a personas en estado crítico establecidos por Patricia Benner, el Proceso de Atención de Enfermería y las taxonomías. Objetivo: Exponer el desarrollo de una intervención de enfermería durante la circulación extracorpórea. Métodos: Se realizó un estudio experimental, que incluyó 159 personas, distribuidas en dos grupos, que acudieron al Servicio de Cardiología, del Centro de Investigaciones Médico Quirúrgicas desde enero de 2018 hasta enero de 2021. Los grupos fueron escogidos mediante la aleatorización simple (1:1). El primero se conformó por 79 personas, abordadas con el procedimiento convencional; y el segundo, por 80, atendidas con la intervención de enfermería diseñada por el equipo de investigación. Se compararon y expresaron los resultados en números absolutos, porcentajes y media. Resultados: Predominaron los hombres (79,7 por ciento). La edad media fue 60 años. En el grupo al que se le aplicó la intervención de enfermería se redujeron la aparición de complicaciones, la estadía en Unidades de Cuidados Intensivos, hospitalaria, y la mortalidad (p = 0,04). Conclusiones: La implementación de la Intervención de Enfermería por el enfermero perfusionista ayudó a mejorar las respuestas humanas de esas personas. Los resultados finales obtenidos mostraron su validez, al evidenciar la disminución en la aparición de complicaciones y, por ende, la reducción de la estadía en UCI, hospitalaria y la mortalidad(AU)
Introduction: A nursing intervention during extracorporeal circulation in cardiovascular surgery can reduce the occurrence of complications, the stay in intensive care units, in hospitals, and mortality. Care is offered by articulating the domains of care for people in critical condition established by Patricia Benner, the Nursing Care Process and taxonomies. Objective: To present the development of a nursing intervention during extracorporeal circulation. Methods: An experimental study was conducted, which included 159 people, divided into two groups, who attended the Cardiology Service of the Center for Medical and Surgical Research from January 2018 to January 2021. Groups were chosen using simple randomization (1:1). The first group was made up of 79 people, approached with the conventional procedure; and the second, by 80 people, attended with the nursing intervention designed by the research team. The results were compared and expressed in absolute numbers, percentages and mean. Results: Men predominated (79.7 percent). The median age was 60 years. In the group to which the nursing intervention was applied, the occurrence of complications, the stay in Intensive Care Units, in hospitals, and mortality were reduced (p = 0.04). Conclusions: The implementation of the Nursing Intervention by the perfusionist nurse helped to improve the human responses of these people. The final results obtained showed their validity, as they showed the decrease in the onset of complications and, therefore, the reduction of ICU and hospital stay and mortality(AU)
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Humans , Middle Aged , Cardiovascular Surgical Procedures/adverse effects , Nursing Care/methodsABSTRACT
Introducción: La alteración en el intercambio gaseoso es una complicación de la cirugía cardíaca con circulación extracorpórea. La causa de este deterioro es multifactorial. Durante la derivación, ambos pulmones colapsan y al término de la circulación extracorpórea los pulmones se vuelven a expandir, sin existir una técnica estándar para ello. La aplicación de reclutamiento alveolar durante la anestesia general en este tipo de cirugía mejora la oxigenación arterial. Objetivo: Describir aspectos esenciales de fisiopatología de la injuria pulmonar asociada a la ventilación mecánica en procedimientos quirúrgicos cardíacos y el efecto de la ventilación mecánica protectora perioperatoria como estrategia para prevenirla. Método: Se realizó una búsqueda de la literatura publicada durante el período comprendido entre enero de 1990 y diciembre de 2020 que hiciera referencia a las estrategias de ventilación mecánica protectora en cirugía cardiovascular. Resultados: La evidencia experimental y clínica sugiere que los bajos volúmenes corrientes de ventilación pulmonar y la aplicación por un corto período del aumento de las presiones inspiratorias, conocidas como "maniobras de reclutamiento" seguidas de la aplicación de presión positiva al final de la espiración para mantener los alveolos reclutados abiertos, incrementan la capacidad residual funcional y reducen la injuria pulmonar asociada a la ventilación mecánica. Estas recomendaciones han sido extrapoladas de estudios retrospectivos realizados en otro tipo de poblaciones. Conclusiones: No existe evidencia contundente de que esta estrategia disminuya la respuesta proinflamatoria, mejore la función pulmonar posoperatoria y disminuya la mortalidad perioperatoria, cuando se compara con la ventilación convencional(AU)
Introduction: The alteration in gas exchange is a complication of cardiac surgery with extracorporeal circulation. The cause of this deterioration is multifactorial. During the shunt, both lungs collapse and at the end of the extracorporeal circulation the lungs expand again, without a standard technique for it. The application of alveolar recruitment during general anesthesia in this type of surgery improves arterial oxygenation. Multiple strategies are used and have as a reference the extracorporeal circulation and its contribution to the pulmonary and systemic inflammatory response. This forces the anesthesiologist to understand the pathophysiology of lung injury associated with mechanical ventilation. Objective: Describe essential aspects of pathophysiology of pulmonary injury associated with mechanical ventilation in cardiac surgical procedures and the effect of perioperative protective mechanical ventilation as a strategy to prevent it. Method: A search of the literature published during the period between January 1990 and December 2020 was carried out that referred to protective mechanical ventilation strategies in cardiovascular surgery. Results: Experimental and clinical evidence suggest that low current volumes of pulmonary ventilation and the application for a short period of increased inspiratory pressures, known as "recruitment maneuvers" followed by the application of positive pressure at the end of expiration to keep the recruited alveoli open, increase functional residual capacity and reduce lung injury associated with mechanical ventilation. These recommendations have been extrapolated from retrospective studies conducted in other types of populations. Conclusions: There is no strong evidence that this strategy decreases the pro-inflammatory response, improves postoperative lung function and decreases perioperative mortality, when compared to conventional ventilation(AU)
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Humans , Thoracic Surgery/methods , Respiration, Artificial/methods , Noninvasive Ventilation/methodsABSTRACT
The purpose of this study is to assess the impact of coronavirus disease 2019 (COVID-19) on the performance of cardiovascular surgery in Japan. The information gathered may be useful to prepare for a surgery in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) positive patients and prevent COVID-19 transmission from surgical patients to healthcare workers. [Methods] A web-based questionnaire was distributed to all accredited cardiovascular surgery centers in Japan. A total of 550 questionnaires were sent, and 310 (56.4%) were returned. [Results] Preoperative PCR or antigen testing was performed in all patients at 68.8% of centers. The proportion of surgeries postponed or cancelled was the highest for elective valvular and aortic surgeries and for emergency aortic surgeries. In most facilities elective surgeries were restricted to less than 50% of usual case volumes, while approximately 40% did not experience any negative impact on the case volume. Among the surgical patients, 32 were suspected to be SARS-CoV-2 positive, and 10 were confirmed. As preventive measures against spreading infection, more than 90% of the patients wore N95 masks, 33.3% full PPE, and 66.7% N95 mask+face shield. No case of patient-to-healthcare-worker transmission was reported. There were no postoperative deaths among the confirmed SARS-CoV-2 patients. [Conclusion] Restriction of surgical practice was placed on many institutions in the COVID-19 pandemic, but the degree of restrictions varied. Preoperative screening of all surgical patients and intraoperative use of PPE in those with suspected or confirmed SARS-CoV-2 infection adequately prevented transmission to healthcare workers. Since COVID-19 has a nationwide impact, it is important to continuously monitor surgical outcomes and infection rate by conducting perioperative surveys of COVID-19 patients.
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@#In the late-breaking trials session of the American Heart Association’s Scientific Sessions 2021, which took place in November 2021, six clinical trials in cardiac surgery published their primary results. This review will look into three of them including the management of patients with moderate or less-than-moderate tricuspid regurgitation at the time of surgery for degenerative mitral regurgitation, timing of ticagrelor cessation before coronary artery bypass grafting, and long-term outcomes of ticagrelor-based antiplatelet therapy for secondary prevention of coronary artery bypass grafting.
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Objective:To explore the effect of scenario simulation combined with "finding fault" teaching method on prevention and control of nosocomial infection training in standardized residency training of cardiovascular surgery.Methods:A total of 31 residents trained in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Naval Medical University from April 2018 to March 2019 were selected as the control group, and another 31 residents trained from April 2019 to March 2020 were selected as the study group. All subjects were required to receive nosocomial infection prevention and control training. The control group was given conventional teaching method, while the study group was given scenario simulation combined with "finding fault" teaching method, all of which were taught for 1 month. The theoretical and operational assessment results of nosocomial infection prevention and control after teaching, the clinical core competence related to nosocomial infection prevention and control after teaching, and the recognition rate of teaching mode were compared between the two groups. SPSS 25.0 was used for t test and chi-square test. Results:The scores of theoretical assessment [(91.29±6.64) vs. (86.73±6.02)] and operational assessment [(90.32±6.80) vs. (83.51±7.43)] of nosocomial infection prevention and control after teaching in the study group were higher than those in the control group, with statistical differences ( P<0.05). The scores of clinical core competence in learning initiative, doctor-patient communication, problem thinking and problem solving of nosocomial infection prevention and control knowledge after teaching in the study group were higher than those in the control group, with statistical differences ( P<0.05). The recognition rates of innovation, interest, effectiveness and practicability of the teaching mode in the study group were 83.87%, 96.77%, 90.32% and 93.55% respectively, while those in the control group were 61.29%, 58.06%, 67.74% and 74.19% respectively, which were higher in the study group than in the control group, with statistically significant differences ( P<0.05). Conclusion:In the training of prevention and control of nosocomial infection for standardized residency training in the department of cardiovascular surgery, scenario simulation combined with "fault finding" teaching method can improve the theoretical and practical examination results of the residents, enhance their clinical core competence related to nosocomial infection prevention and control, and reach a higher recognition rate of the teaching mode.
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Objective:To analyze the application value of PAD (Presentation-Assimilation-Discussion) class and case teaching combined with brainstorming in the practice teaching of nursing students in the department of cardiovascular surgery.Methods:A total of 81 undergraduate nursing students who practiced in the Department of Cardiovascular Surgery, The First Affiliated Hospital of Air Force Medical University from June 2019 to April 2020 were selected as the research objects. They were randomly divided into the control group ( n=40, brainstorming teaching) and the observation group ( n=41, PAD class combined with case teaching). After one month of intervention, the teaching effect on the two groups of nursing students were evaluated through the nursing students' clinical communication ability scale, Chinese version of self-assessment of clinical reflection and reasoning (SACRR), and competency inventory for registered nurse (CIRN). And the teaching quality was assessed by the clinical nursing teacher teaching behavior assessment scale. SPSS 22.0 was used for t-test. Results:The scores of each dimension and total scores of clinical communication ability scale, Chinese version SACRR and CIRN of nursing students in the observation group were higher than those in the control group ( P<0.05). The scores of nursing teaching behavior evaluation of clinical teachers in the observation group were higher than those in the control group ( P<0.05). Conclusion:The combination of PAD class and case teaching with brainstorming can improve the clinical communication ability of nursing students in cardiovascular surgery practice, help to promote the transformation of their clinical thinking ability, improve their core competences, and play an important role in improving the teaching quality.
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Abstract Introduction and Objective Cardiac tumors are often unrecognized until autopsies are performed or diagnosed from routine studies based on unspecific symptoms. The most common type of tumor is the myxoma, although rare, upon diagnosis an urgent surgical resection is often required. Previously the ideal surgical approach was a standard median sternotomy, however recently newer surgical techniques have been employed with excellent results. We describe a recent surgical approach via the right lateral minithoracotomy as a minimally invasive intervention with three cases that evidence an appropriate and ideal surgical approach. Method and Patients We present three cases of minimally invasive myxoma resection via the right lateral minithoracotomy. Results and discussion In this three-case series study, no complications were reported peri-operatively nor at the 6 and 12-month follow-ups. In comparison with international literature, surgical approaches in Colombia are comparable with successful resection and little or no complications peri-operatively. Conclusions The right lateral minithoracotomy appears to be a safe approach in myxoma resection. We hope to enhance and promote the surgical community in Colombia to opt for alternative less invasive approaches in these type of cases, to ensure excellent results and promote further research as seen in other countries.
Resumen Introducción y Objetivo Los tumores cardíacos no suelen ser diagnosticados hasta la realización de autopsia o en otros casos como hallazgos incidentales. El tumor cardiaco más común es el mixoma, aunque es poco frecuente; en el momento del diagnóstico a menudo se requiere una resección quirúrgica urgente. Anteriormente el enfoque quirúrgico era una atriotomía abierta derecha; sin embargo, recientemente se han empleado técnicas quirúrgicas nuevas con excelentes resultados. Describimos una técnica quirúrgica reciente a través de la minitoracotomía lateral derecha como un método mínimamente invasivo con tres casos que evidencian un método quirúrgico apropiado e ideal. Métodos y pacientes: Se presentan tres casos de resección mínimamente invasiva de mixomas a través de una minitoracotomía lateral derecha. Resultados y discusión: Es estos tres casos no se reportaron complicaciones perioperatorias ni durante el seguimiento a los 6 y 12 meses. En comparación con otras series de casos en la literatura, el enfoque en Colombia ha sido comparable tanto en los resultados exitosos como con las técnicas quirúrgicas, sin complicaciones asociadas. Conclusiones La minitoracotomía lateral derecha puede ser considerada segura en resección de mixoma. Con este tipo de reportes se espera suscitar en la comunidad médica la elección de alternativas quirúrgicas mínimamente invasivas para garantizar excelentes resultados y promover la investigación, como se evidencia en el resto del mundo.