Predictors of patient-reported health following cardiac surgery.

BACKGROUND: Patient-reported health status is one of the most important aspects of cardiovascular outcomes. The aim of this study was to assess patient-reported health and its determinants following cardiac surgery. METHODS: Cross-sectional study was performed among 128 patients (mean age: 66.02; 35.9% women). Three months after surgery patients filled in The Short Form 12 Health Survey (SF-12) and Brief-Illness Perception Questionnaire (B-IPQ). Patient-reported health was assessed using SF-12 General Health component. RESULTS: The mean General Health score was 47.34 (SD=20.94). General Health was significantly positively correlated with SF-12 Physical and Mental Component Summary (P<0.01). Significant negative correlations were noted between General Health and European System for Cardiac Operative Risk Factor (EuroSCORE) (P=0.012) and Body Mass Index (BMI) (P=0.026). Higher scores on B-IPQ Consequences, Timeline, Identity, Emotional Response (P<0.01) and Concern (P=0.03) were related to worse General Health. Higher perceived effectiveness of surgery (P<0.01) and Treatment control (P=0.003) were associated with higher General Health score. More negative illness perception was significantly related to lower General Health (P<0.01). No significant associations between General Health and mode and weight of the procedure, myocardial infarction, previous percutaneous coronary intervention, New York Heart Association (NYHA) and Canadian Cardiovascular Society (CCS) class and postsurgical complications were noted. Structural equation modeling (SEM) revealed that illness perception domains, BMI and EuroSCORE are the main determinants of General Health. CONCLUSIONS: Modifiable factors, especially illness perception are important determinants of patient-reported health after cardiac surgery. Evaluation of illness perception seems vital since it may lead to address patients' concerns and improve outcomes.

Factors Associated with High Preoperative Anxiety: Results from Cluster Analysis.

BACKGROUND: Preoperative anxiety is a common patients' reaction related to serious adverse events post-operatively. The aim was to explore the characteristics of cardiac surgery patients experiencing high preoperative anxiety. METHODS: A total of 127 patients (mean age 64.48 years; 34.6% women) assessed their level of anxiety while waiting for surgery, need for information, depression and illness perception with the use of Amsterdam Preoperative Anxiety and Information Scale, Visual Analogue Scale, Hospital Anxiety and Depression Scale and Brief Illness Perception Questionnaire, respectively. Clinical and socio-demographic data were gathered using structured interview and medical files review. K-means and hierarchical cluster analyses were performed. α 0.05 was considered significant. RESULTS: The analysis revealed two different clusters: Cluster 1 involved 46 patients (36.2%; mean age 58.91); Cluster 2 involved 81 patients (63.8%; mean age 67.65). Patients from Cluster 2 had significantly higher anxiety on the day prior to surgery (12.09 vs. 7.93), at a decision stage (6.16 vs. 3.85) and during prehospitalization week (8.01 vs. 4.41). These patients also had more negative illness perception (43.84 vs. 28.35), depressive symptoms (4.9 vs. 2.5) and higher information desire (6.68 vs. 5.54) than patients from Cluster 1. Female sex and planned combined surgery were additional contributors to higher anxiety. CONCLUSIONS: Patients scheduled for cardiac surgery experienced high anxiety throughout the presurgery period. Early intervention addressing not only anxiety but also illness perception and depressive symptoms seems vital. The results can be helpful in planning tailored, needs-based psycho-educational intervention which might improve patients' preoperative psychological state.

Malignant triton tumor of the lung, infiltrating the left atrium and left ventricle, with metastasis to the small intestine.

Malignant triton tumors are a rare subtype of malignant peripheral nerve sheath tumors showing rhabdomyosarcomatous differentiation. We report the case of a 33-year-old patient who underwent an excision of such a tumor by thoracic and cardiac surgery. He was reoperated on 1 month later because of a tumor of the small intestine and received adjuvant radiation.

[Extraction of chronically implanted transvenous pacing and defibrillator leads - cost analysis]. / Przezzylne usuwanie elektrod stymulatorów i kardiowerterów−defibrylatorów serca ­ analiza kosztów.

Due to the rapid increase in the number of patients with implanted pacemakers (PM) or cardioverter-defibrillators (ICD), the incidence of complications of this method of treatment also increases. In many cases the only solution is transvenous extraction of previously implanted PM/ICD system. The publication is an attempt to assess the real cost of performing such procedures.

[Effect of transmyocardial laser revascularization on the myocardium in the early postoperative period]. / Ocena wplywu przezmiesniowej rewaskularyzacji laserowej na stan miesnia sercowego we wczesnym okresie pooperacyjnym.

BACKGROUND: Transmyocardial laser revascularization (TMLR) is a modem approach in the management of coronary artery disease. It can be considered as a method of choice in some cases unsuitable for coronary angioplasty or bypass grafting. Transmyocardial laser revascularization is expected to relieve angina and to improve patient quality of life and survival. The aim of the study was to determine whether the laser energy released during TMLR induces any myocardial deterioration, which could affect the heart status and function in early postoperative period. METHODS: A group of 80 patients with CAD (37 TMLR/CABG, 43 CABG) was evaluated within 24 hours after the procedure for CK-MB and cTnT concentrations to determine myocardial injury. Elective hemodynamic indexes were used to determine the heart function. The cardiac rhythm disturbances were recorded by Holter monitoring. Homeostatic disturbances and postoperative complications were also recorded. RESULTS: The postoperative CK-MB and cTnT levels were significantly higher in the TMLR g roup (ANOVA: p < 0.001 and p = 0.013), with significantly high correlation of laser energy and number of channels with CK-MB(max) concentration (Pearson coefficient of correlation 0.614 and 0.561, p < 0.0001) and non significant correlation with cTnT(max) concentration. No significant differences between the TMLR and the CABG group regardinghemodynamic indexes were observed. Significantly more patients in the TMLR group had ventricular events (VE) within 24 postoperative hours (27 vs 10, chi 2: p < 0.0001), reguiring antyarrhythmic drugs administration (13 vs 2, chi2: p < 0.0008). The number of channels created in a group of patients with VE was significantly higher (21.8+/- 7.66 vs 15.7 +/- 7.63; p = 0.0255). No significant difference in postoperative blood loss was observed. Significantly more patients from the TMLR group received blood (37/37 vs 36/43 in CABG group, chi2: p = 0.029), but no significant difference in number of blood units used was observed (3.22 +/- 1.8 U. in TMLR group vs 2.92 +/- 1.52 U. in CABG group: p = 0.445). Significantly more patients needed postoperatively inotropic support in the TMLR group (10 vs 2, chi2; p = 0.019). One patient from the TMLR group had low output syndrome (IAB support) and one from the CABG group had postoperative myocardial infarction. CONCLUSION: The laser energy released during TMLR injures th e myocardium (CK-MB, cTnT, VE) but does notaffect the heart function (hemodynamic status, postoperative course).