ABSTRACT
INTRODUCTION: The robotic platform reduces the invasiveness of cardiac surgical procedures, thus facilitating earlier discharge in select patients. We sought to evaluate the characteristics, perioperative management, and early outcomes of patients who underwent postoperative day 1 or 2 (POD1-2) discharge after robotic cardiac surgery at our institution. METHODS: Retrospective review of 169 patients who underwent robotic cardiac surgery at our facility between 2019 and 2021 identified 57 patients discharged early on POD1 (n = 19) or POD2 (n = 38) and 112 patients who underwent standard discharge (POD3 or later). Relevant data were extracted and compared. RESULTS: In the early discharge group, median patient age was 62 [IQR: 55, 66] (IQR = interquartile range) years, and 70.2% (40/57) were male. Median Society of Thoracic Surgeons predictive risk of mortality score was 0.36 [IQR: 0.25, 0.56] %. The most common procedures performed were mitral valve repair [66.6%, (38/57)], atrial mass resection [10.5% (6/57)], and coronary artery bypass grafting [10.5% (6/57)]. The only significant differences between the POD1 and POD2 groups were shorter operative time, higher rate of in-operating room extubation, and shorter ICU length of stay in the POD1 group. Lower in-hospital morbidity and comparable 30-day mortality and readmission rates were observed between the early and standard discharge groups. CONCLUSIONS: POD1-2 discharge after various robotic cardiac operations afforded lower morbidity and similar 30-day readmission and mortality rates compared to discharge on POD3 or later. Our findings support the feasibility of POD1-2 discharge after robotic cardiac surgery for patients with low preoperative risk, an uncomplicated postoperative course, and appropriate postoperative management protocols.
Subject(s)
Cardiac Surgical Procedures , Robotic Surgical Procedures , Humans , Male , Aged , Female , Robotic Surgical Procedures/adverse effects , Robotic Surgical Procedures/methods , Patient Discharge , Feasibility Studies , Cardiac Surgical Procedures/adverse effects , HeartABSTRACT
OBJECTIVE: The aim of this study was to study the association of perioperative administration of renin angiotensin system inhibitors (RASi) and clinical outcomes of patients with heart failure (HF) undergoing cardiac surgery. SUMMARY BACKGROUND DATA: It is controversial whether the perioperative RASi should be administered in HF patients undergoing cardiac surgery. METHODS: A total of 2338 patients with HF and undergoing CABG and/or valve surgeries at multiple hospitals from 2001 to 2015 were identified from STS database. After adjustment using propensity score and instrumental variable, logistic regression was conducted to analyze the influence of preoperative continuation of RASi (PreRASi) on short-term in-hospital outcomes. Independent risk factors of 30-day mortality, major adverse cardiovascular events (MACE), and renal failure were analyzed by use of stepwise logistic regression. The effects of pre- and postoperative use of RASi (PostRASi) on long-term mortality were analyzed using survival analyses. Stepwise Cox regression was conducted to analyze the independent risk factors of 6-year mortality. The relationships of HF status and surgery type with perioperative RASi, as well as PreRASi-PostRASi, were also evaluated by subgroup analyses. RESULTS: PreRASi was associated with lower incidences of 30-day mortality [ P < 0.0001, odds ratio (OR): 0.556, 95% confidence interval (CI) 0.405-0.763], stroke ( P =0.035, OR: 0.585, 95% CI: 0.355-0.962), renal failure ( P =0.007, OR: 0.663, 95% CI: 0.493-0.894). Both PreRASi ( P =0.0137) and PostRASi ( P =0.007) reduced 6-year mortality compared with the No-RASi groups. CONCLUSIONS: Pre- and postoperative use of RASi was associated with better outcomes for the patients who have HF and undergo CABG and/or valve surgeries. Preoperative continuation and postoperative restoration are warranted in these patients.
Subject(s)
Cardiac Surgical Procedures , Heart Failure , Renal Insufficiency , Humans , Renin-Angiotensin System , Cohort Studies , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/pharmacology , Heart Failure/surgeryABSTRACT
The Tempo® Temporary Pacing Lead is a temporary, transvenous, active fixation pacemaker lead used exclusively in structural heart and electrophysiology procedures since regulatory approval in 2016. We utilized the Tempo lead for four patients undergoing redo-robotic cardiac surgery in which surgical epicardial leads could not be placed. No failure-to-pace events were encountered and patients were able to participate in various levels of physical activity without limitation.
Subject(s)
Cardiac Pacing, Artificial , Cardiac Surgical Procedures , Pacemaker, Artificial , Humans , Reoperation , Robotic Surgical ProceduresSubject(s)
COVID-19 , Internship and Residency , Education, Medical, Graduate , Humans , Pandemics , SARS-CoV-2ABSTRACT
Amiodarone is an effective antiarrhythmic that frequently is used during the perioperative period. Amiodarone possesses a significant adverse reaction profile. Amiodarone-induced pulmonary toxicity (AIPT) is among the most serious adverse effects and is a leading cause of death associated with its use. Despite significant advances in the understanding of AIPT, its etiology and pathogenesis remain incompletely understood. The diagnosis of AIPT is one of exclusion. The clinical manifestations of AIPT are categorized broadly as acute, subacute, and chronic. Acute AIPT is a rarer and more aggressive form of the disease, most often encountered in cardiothoracic surgery. Acute respiratory distress syndrome (ARDS) is the predominating pattern of amiodarone's acute pulmonary toxicity. The incidence, risk factors, pathogenesis, and diagnosis of acute AIPT are speculative. Early cardiothoracic literature investigating AIPT often attributed amiodarone to the development of postoperative ARDS. Subsequent studies have found no association between amiodarone and acute AIPT and ARDS development. As a drug that is frequently prescribed to a patient population deemed most at risk for this fatal disease, the conflicting evidence on acute AIPT needs further investigation and clarification.
Subject(s)
Amiodarone , Drug-Related Side Effects and Adverse Reactions , Lung Diseases , Respiratory Distress Syndrome , Amiodarone/adverse effects , Anti-Arrhythmia Agents/adverse effects , Humans , Respiratory Distress Syndrome/chemically induced , Respiratory Distress Syndrome/diagnosisABSTRACT
It remains disputable about perioperative use of renin-angiotensin system inhibitors (RASi) and their outcome effects. This multicenter retrospective cohort study examines association between use of perioperative RASi and outcomes in patients undergoing coronary artery bypass graft and/or valve surgery. After the exclusion, the patients are divided into 2 groups with or without preoperative RASi (PreRASi, n = 8581), or 2 groups with or without postoperative RASi (PostRASi, n = 8130). With using of propensity scores matching to reduce treatment selection bias, the study shows that PreRASi is associated with a significant reduction in postoperative 30-day mortality compared with without one (3.41% vs. 5.02%); PostRASi is associated with reduced long-term mortality rate compared with without one (6.62% vs. 7.70% at 2-year; 17.09% vs. 19.95% at 6-year). The results suggest that perioperative use of RASi has a significant benefit for the postoperative and long-term survival among patients undergoing cardiac surgery.
Subject(s)
Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Perioperative Care , Renin-Angiotensin System/drug effects , Aged , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Coronary Artery Bypass , Female , Heart Valves/surgery , Humans , Male , Retrospective Studies , Treatment OutcomeSubject(s)
Coronary Artery Bypass/adverse effects , Intubation, Intratracheal/adverse effects , Pneumothorax/diagnostic imaging , Postoperative Complications/diagnostic imaging , Shock/diagnostic imaging , Aged , Humans , Male , Pneumothorax/etiology , Postoperative Complications/etiology , Shock/etiologySubject(s)
Autonomic Nervous System Diseases/therapy , Bronchi/injuries , Extracorporeal Membrane Oxygenation/methods , Flushing/therapy , Hypohidrosis/therapy , Intraoperative Care/methods , Thoracic Injuries/complications , Thoracic Surgical Procedures/methods , Trachea/injuries , Adolescent , Autonomic Nervous System Diseases/etiology , Bronchoscopy , Flushing/etiology , Humans , Hypohidrosis/etiology , Laryngoscopy/methods , Male , Thoracic Injuries/diagnosis , Thoracic Injuries/surgery , Trauma Severity IndicesSubject(s)
Cardiac Tamponade/diagnostic imaging , Cardiac Tamponade/surgery , Drainage/adverse effects , Heart Failure/diagnostic imaging , Ventricular Dysfunction, Right/diagnostic imaging , Acute Disease , Adult , Drainage/methods , Female , Heart Failure/etiology , Humans , Pericardiocentesis/adverse effects , Pericardiocentesis/methods , Thoracic Surgery, Video-Assisted/adverse effects , Thoracic Surgery, Video-Assisted/methods , Ventricular Dysfunction, Right/etiologyABSTRACT
The treatment for aortic stenosis is evolving rapidly with new developments in transcatheter aortic valve replacement (TAVR). While the procedure was initially performed under general anesthesia with invasive monitoring and transesophageal echocardiography, recent trends have shifted toward less invasive strategies. Transfemoral TAVRs are frequently performed under sedation; however, TAVRs using alternative access sites, such as the subclavian artery, are typically performed under general anesthesia. This case series describes 3 patients who underwent subclavian TAVR under combined pectoralis and interscalene blocks. All patients tolerated the procedure without complication, requiring no airway manipulation and minimal postoperative analgesia.