RESUMO
This case illustrates that transfemoral transcatheter aortic valve replacement is safe and feasible in patients with bicuspid aortic stenosis with extremely large annulus and concomitant severe left ventricular dysfunction.
Assuntos
Doença da Válvula Aórtica Bicúspide , Substituição da Valva Aórtica Transcateter , Disfunção Ventricular Esquerda , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Humanos , Masculino , Substituição da Valva Aórtica Transcateter/efeitos adversos , Resultado do Tratamento , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/etiologiaAssuntos
Anticoagulantes/administração & dosagem , Heparina/efeitos adversos , Hirudinas/administração & dosagem , Cuidados Intraoperatórios/métodos , Fragmentos de Peptídeos/administração & dosagem , Trombocitopenia/induzido quimicamente , Substituição da Valva Aórtica Transcateter/tendências , Idoso , Gerenciamento Clínico , Artéria Femoral , Humanos , Masculino , Proteínas Recombinantes/administração & dosagem , Trombocitopenia/diagnóstico , Trombocitopenia/tratamento farmacológico , Substituição da Valva Aórtica Transcateter/efeitos adversosRESUMO
The purpose of the present investigation was to examine the impact of blood transfusion on resource utilisation, morbidity and mortality in patients undergoing coronary artery bypass graft (CABG) surgery at a major university hospital. The resources we examined are time to extubation, intensive care unit length of stay (ICULOS) and postoperative length of stay (PLOS). We further examined the impact of number of units of packed red blood cells (PRBCs) transfused during PLOS. This is a retrospective observational study and includes 1746 consecutive male and female patients undergoing primary CABG (on- and off-pump) at our institution. Of these, 1067 patients received blood transfusions, while 677 did not. The data regarding the demography, blood transfusion, resource utilisation, morbidity and mortality were collected from the records of patients undergoing CABG over a period of three years. The mean time to extubation following surgery was 8.0 h for the transfused group and 4.3 h for the nontransfused group ( P Assuntos
Transfusão de Sangue/economia
, Ponte de Artéria Coronária/economia
, Ponte de Artéria Coronária/mortalidade
, Reação Transfusional
, Idoso
, Anestesia Geral
, Cuidados Críticos/economia
, Cuidados Críticos/estatística & dados numéricos
, Interpretação Estatística de Dados
, Transfusão de Eritrócitos
, Feminino
, Recursos em Saúde/estatística & dados numéricos
, Testes de Função Cardíaca
, Humanos
, Intubação Intratraqueal
, Tempo de Internação
, Masculino
, Pessoa de Meia-Idade
, Complicações Pós-Operatórias/epidemiologia
, Complicações Pós-Operatórias/mortalidade
RESUMO
OBJECTIVE: The purpose of the present study was to examine resource utilization in octogenarians undergoing coronary artery bypass grafting (CABG) and compare it with usage in their younger cohorts at a tertiary care heart center. The resources examined were time to extubation, packed red blood cell transfusions, intensive care unit (ICU) length of stay (LOS), and preoperative and postoperative LOS. The study also examined differences in postoperative morbidity and mortality. DESIGN: Retrospective hospital follow-up study of consecutive patients undergoing CABG using a prospectively designed database. SETTING: University teaching tertiary care referral center for cardiac surgery. PARTICIPANTS: Seventeen hundred forty-six male and female patients undergoing CABG surgery, including 155 octogenarians and 1591 patients younger than 80 years. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Demographic, mortality, morbidity, and resource utilization data were collected from the records of patients undergoing CABG at the authors' institution over 3 years. There were 1746 patients: 155 octogenarians and 1591 nonoctogenarians. Octogenarians had a significantly higher incidence of preoperative stroke, peripheral vascular disease, chronic obstructive lung disease, congestive heart failure, and left main disease. They weighed significantly less, and had lower preoperative and postoperative hematocrit. There was a significantly higher percentage of women in the octogenarian group. Mean time from the end of surgery to endotracheal extubation was 9.3 hours for octogenarians and 6.3 hours for their younger cohorts (p < 0.001). Blood transfusion was required in 88.4% of octogenarians compared with 58.6% of nonoctogenarians (p < 0.001). Mean ICU LOS was 1.9 days for octogenarians and 1.4 days for nonoctogenarians (p < 0.001). Mean postoperative LOS was 8.7 days for octogenarians and 5.8 days for nonoctogenarians (p < 0.001). Clinical and demographic variables were correlated with age 80 years or older. Multivariate linear and logistic regression models were constructed to show the combined effects of age and comorbid conditions on outcomes. Octogenarians had a significantly higher incidence of postoperative renal failure and neurologic complications. The 30-day mortality rate was 9.0% for the octogenarian group v 1.2% for the younger group (p < 0.001). Age 80 years or older was significantly associated with outcome, and was an independent predictor of increased resource utilization and postoperative mortality and morbidity. CONCLUSIONS: The results demonstrated that octogenarians undergoing CABG required increased resource utilization and had significantly higher morbidity, with increased incidence of postoperative renal failure, neurologic complications, and 30- day mortality. Age 80 years or older was an independent predictor of increased resource utilization, postoperative morbidity, and mortality.
Assuntos
Ponte de Artéria Coronária , Doença das Coronárias/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Ponte Cardiopulmonar , Feminino , Seguimentos , Recursos em Saúde/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Artéria Torácica Interna/cirurgia , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
OBJECTIVE: The purpose of the present investigation was to examine factors influencing resource utilization in patients undergoing on-pump coronary artery bypass graft and off-pump coronary artery bypass (OPCAB) graft surgery at a major university hospital. The resources examined were time to extubation, packed red blood cell (PRBC) transfusion, intensive care length of stay (ICULOS), preoperative and postoperative length of stay (PLOS), and total length of stay (LOS). DESIGN: Observational study of consecutive patients undergoing on- and off-pump coronary artery bypass surgery. SETTING: Tertiary care cardiac referral center. PARTICIPANTS: One thousand seven hundred forty-six consecutive male and female patients undergoing primary coronary artery bypass graft (CABG) surgery over a period of 3 years (1999-2001). Eight hundred eighty-one patients underwent CABG with pump, and 865 patients underwent off-pump coronary artery bypass (OPCAB) surgery. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The mean time to extubation after surgery was 7.4 hours for on-pump patients and 5.8 hours for the OPCAB group (p
Assuntos
Anestesia , Ponte de Artéria Coronária sem Circulação Extracorpórea , Recursos em Saúde/estatística & dados numéricos , Tempo de Internação , Idoso , Anestesia/métodos , Procedimentos Cirúrgicos Cardíacos/economia , Ponte de Artéria Coronária sem Circulação Extracorpórea/economia , Feminino , Humanos , Tempo de Internação/economia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos RetrospectivosRESUMO
UNLABELLED: This case report describes damage to a pulmonary artery catheter (PAC) during transmyocardial laser revascularization. We observed persistent bleeding and a temperature reading of "too high" from the temperature connection port of PAC during cardiopulmonary bypass while the patient's nasopharyngeal temperature read 34 degrees C. This alerted us to the possibility of PAC damage during creation of laser channels in the right coronary artery territory on the inferior surface of the heart. This is a unique complication related to this coronary revascularization procedure. IMPLICATIONS: We report an unusual case of pulmonary artery catheter (PAC) damage during transmyocardial laser revascularization (TMLR). This observation should alert the anesthesiologist to the fact that the PAC may be damaged when TMLR is performed on the right side of the heart. We recommend that the PAC be withdrawn during this procedure.
Assuntos
Cateterismo de Swan-Ganz/instrumentação , Complicações Intraoperatórias/etiologia , Terapia a Laser , Revascularização Miocárdica/efeitos adversos , Temperatura Corporal/fisiologia , Vasos Coronários/cirurgia , Falha de Equipamento , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Anestesia/métodos , Parada Cardíaca/terapia , Ruptura Cardíaca/diagnóstico , Ruptura Cardíaca/cirurgia , Anestésicos Intravenosos/uso terapêutico , Gasometria/métodos , Pressão Sanguínea/fisiologia , Ponte Cardiopulmonar/métodos , Reanimação Cardiopulmonar/métodos , Cateterismo de Swan-Ganz/métodos , Ponte de Artéria Coronária/métodos , Ecocardiografia Transesofagiana/métodos , Etomidato/uso terapêutico , Feminino , Parada Cardíaca/complicações , Ruptura Cardíaca/etiologia , Humanos , Intubação Intratraqueal/métodos , Midazolam/uso terapêutico , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Infarto do Miocárdio/complicações , Infarto do Miocárdio/cirurgia , Fármacos Neuromusculares não Despolarizantes/uso terapêutico , Brometo de Vecurônio/uso terapêuticoRESUMO
UNLABELLED: We investigated the impact of cardiopulmonary bypass pump (CPB), hematocrit, gender, age, and body weight on blood use in patients undergoing coronary artery bypass graft surgery at a major university hospital. Participants were 1235 consecutive patients undergoing primary coronary artery surgery over a period of 2 yr (1999 and 2000); 681 patients underwent coronary surgery with use of CPB, and 554 patients underwent off-pump coronary artery bypass surgery using a median sternotomy incision. There were 881 males and 354 females. Average packed red blood cells (PRBC) transfusion for patients on CPB was 3.4 U compared with 1.6 U for the off-pump group (P = <0.001). Patients on CPB received more frequent PRBC transfusion (72.5%) compared with 45.7% of off-pump patients (P = <0.001). Average PRBC transfusion for males was 2.2 U compared with 3.6 U for females (P = <0.001). A lower percentage of males (52.6%) than females (79.4%) received transfusion (P = <0.001). The impact of CPB, off-pump status, preoperative hematocrit <35%, gender, age >or=65 yr, and weight Assuntos
Transfusão de Sangue/estatística & dados numéricos
, Ponte Cardiopulmonar/instrumentação
, Ponte de Artéria Coronária
, Circulação Extracorpórea/efeitos adversos
, Hematócrito
, Adulto
, Idoso
, Envelhecimento/fisiologia
, Peso Corporal/fisiologia
, Bases de Dados Factuais
, Transfusão de Eritrócitos
, Circulação Extracorpórea/instrumentação
, Feminino
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Estudos Prospectivos
, Fatores de Risco
, Caracteres Sexuais
RESUMO
OBJECTIVE: The purpose of the present study was to examine if gender influences duration of tracheal intubation, blood transfusion needs, intensive care unit length of stay (ICULOS), postoperative length of stay (PLOS), and total length of stay (LOS) in patients undergoing off-pump coronary artery bypass (OPCAB) surgery. DESIGN: Retrospective study of consecutive patients undergoing OPCAB surgery. SETTING: University teaching hospital. Tertiary care referral center for cardiac surgery. PARTICIPANTS: Three hundred seventy-two consecutive male and female patients undergoing OPCAB surgery. There were 110 women and 262 men. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Gender, duration of tracheal intubation, units of blood transfused, ICULOS, PLOS, and LOS were collected from the records of patients undergoing OPCAB surgery at the authors' institution over a period of 16 months. There were a total of 372 patients: 110 women and 262 men. Median intubation time was 4.5 hours for women and 4.0 hours for men (p = 0.749); 59.1% of women received red blood cells versus 31.3% of men (p < 0.001). Median ICU LOS was 1 day for women and 1 day for men (p = 0.597) Median PLOS was 4 days for women and 4 days for men. Median LOS was 8 days for women and 6 days for men (p = 0.001). CONCLUSION: Female sex was a predictor of increased blood transfusion and longer PLOS and LOS in patients undergoing OPCAB surgery. The study implies that female sex does not predict increased duration of tracheal intubation and mechanical ventilation and ICULOS in this group of patients. Females undergoing OPCAB surgery require increased resource utilization as measured by increases in blood transfusion, PLOS, and LOS.