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1.
Ann Card Anaesth ; 24(4): 470-472, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34747756

RESUMO

Hydatid infection of the heart is rare and there is always the lethal hazard of cyst perforation. We present an 18-year-old male from Kashmir valley who was admitted to the emergency department of our hospital with fever and chest pain for the last 4 days. Using echocardiography and cardiac tomography (CT), cardiac Echinococcosis was diagnosed. The results of surgical treatment of cardiac Echinococcosis were better than the conservative strategy. Surgical excision was performed. The patient had an uneventful recovery.


Assuntos
Equinococose , Cardiopatias , Adolescente , Dor no Peito , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Ecocardiografia , Coração , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Masculino
3.
Rio de Janeiro; INC; ago. 2021.
Não convencional em Português | BRISA/RedTESA | ID: biblio-1284262

RESUMO

INTRODUÇÃO: A prevenção da hipotermia é recomendada para todos os pacientes que serão submetidos ao procedimento anestésico cirúrgico. Durante o intra-operatório, a hipotermia acomete com frequência o paciente e pode ser prejudicial quando não intencional, não diagnosticada a tempo ou não controlada, associando a várias complicações, podendo também ser benéfica quando intencional. A hipotermia intencional é indicada para a proteção de órgãos vitais (por exemplo, células neuronais e miocárdicas) quando a isquemia é esperada. Nos procedimentos cardíacos onde há necessidade de hipotermia intencional ou hipotermia global profunda utiliza-se a parada circulatória total com comunicação ou circulação extracorpórea (CEC), a qual é a principal técnica. A hipotermia não intencional é definida como a temperatura corporal central menor que 36ºC e é um evento comum no perioperatório. FICHA TÉCNICA DA TECNOLOGIA: Os sistemas que são apresentados aqui são de normotermia, ou seja, não preveem resfriamento, apenas oferecem calor. De acordo com as evidências apresentadas acima, os sistemas que mostraram pequena na prevenção da hipotermia perioperatória não intencional foram o sistema de aquecimento por circulação de ar forçado aquecido e por circulação de água aquecida. Ambos são considerados seguros. Por uma necessidade do setor cirúrgico do INC, serão apresentadas apenas as mantas de aquecimento chamadas de underbody, que ficam debaixo de todo o corpo do paciente. Há diversos modelos de mantas para parte superior, inferior, cobertores com abertura e tamanho infantil, porém houve interesse apenas nas underbody tamanho adulto, por se tratar de um hospital que faz cirurgias cardíacas, de peito aberto, e que o acesso a regiões de membros inferiores também pode ser necessário. EVIDÊNCIAS ECONÔMICAS: A análise econômica foi feita em um modelo de árvore de decisão com as opções de aquisição para 3 salas cirúrgicas ou para 3 salas cirúrgicas e mais uma de procedimentos, totalizando 4 salas. A razão para escolha de um ou de outro depende do modelo de sistema de aquecimento escolhido, pois o que utiliza água não poderia ser usado na sala para procedimentos. As possibilidades foram calculadas sob as modalidades compra, comodato ou aluguel. O orçamento obtido foi da empresa ArtMedical com equipamentos da fabricante Gentherm®. Preços da empresa Sensymed® e de fornecedor da 3M© também foram obtidos, mas estavam em maior valor que o anterior. Ainda foram obtidos orçamentos públicos por meio do sítio de compras governamentais Painel de Preços, este apenas na modalidade comodato. CONSIDERAÇÕES FINAIS: O relatório apresenta revisões sistemática e ensaio clínico que avaliavam a necessidade para prevenir a hipotermia não intencional durante cirurgias e quais seriam os melhores sistemas de aquecimento cutâneo pré e transoperatório. Embora não tenha havido unanimidade de resultados, observou-se que houve comprovação do benefício do aquecimento corporal tanto antes, quanto durante a cirurgia; que os sistemas ativos se mostraram superiores aos passivos; e que entre todos, os sistemas de ar forçado ou circulação de água mostraram ligeira superioridade. De acordo com a avaliação econômica apresentada, independente se a decisão do gestor for de adquirir equipamentos para 3 ou 4 salas, os valores para compra se mostraram mais econômicos no longo prazo. Porém, para tanto, outros contratos de manutenção preventiva e corretiva, e de fornecimento de peças, deverão ser licitados em paralelo com o da compra. A utilização do sistema de ar forçado seria vantajosa caso defina-se que é necessário um kit para aquecimento corporal também na sala de procedimentos. Em relação ao preço público, observou-se uma variação grande entre o menor e o maior preço encontrado. A depender do preço obtido na licitação, esse sistema que utiliza o modelo de comodato, pode apresentar preços competitivos com o de compra dos itens. Isso pode ser vantajoso para o Instituto no interesse de ter máquinas com a manutenção sempre realizada.


Assuntos
Humanos , Salas Cirúrgicas/métodos , Cardiopatias/cirurgia , Calefação/métodos , Avaliação em Saúde/economia , Análise Custo-Benefício/economia
4.
J Am Heart Assoc ; 10(16): e020513, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34350777

RESUMO

Background Women have traditionally been underrepresented in randomized clinical trials (RCTs). We performed a systematic evaluation of the inclusion of women in cardiac surgery RCTs published in the past 2 decades. Methods and Results MEDLINE, EMBASE, and the Cochrane Library were searched (2000 to July 2020) for RCTs written in English, comparing ≥2 adult cardiac surgical procedures. The percentage of women enrolled and its association with year of publication, sample size, mean age, funding source, geographic location, number of sites involved, and interventions tested were analyzed using a meta-analytic approach. Fifty-one trials were included. Of 25 425 total patients, 5029 were women (20.8%; 95% CI, 17.6-24.4; range, 0.5%-57.9%). The proportion of women dropped significantly during the study period (29.6% in 2000 versus 13.1% in 2019, P<0.001). Women were significantly more represented in European trials (26.2%; 95% CI, 21.2-31.9), and less represented in trials of coronary bypass surgery versus other interventions (16.8%; 95% CI, 12.3-22.7 versus 33.6%; 95% CI, 27.4-40.5; P=0.0002) and in trials enrolling younger patients (P=0.009); the percentage of women was higher in industry-sponsored versus non-industry sponsored trials (31.7%; 95% CI, 27.2-36.6 versus 15.5%; 95% CI, 10.0-23.2; P=0.0004) and was not associated with trial sample size (P=0.52) or study design (multicenter versus monocenter: P=0.22). After exclusion of trials conducted at Veteran Affairs centers, women representation was 24.4% (95% CI, 21.1-28.0; range, 10.4%-57.9%), with no significant changes during the study period. Conclusions The proportion of women in cardiac surgery trials is low and likely inadequate to provide meaningful estimates of the treatment effect.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Cardiopatias/cirurgia , Seleção de Pacientes , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Cardiopatias/diagnóstico , Cardiopatias/epidemiologia , Humanos , Masculino , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores Sexuais , Fatores de Tempo
5.
CMAJ Open ; 9(3): E777-E787, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285057

RESUMO

BACKGROUND: The identification of frailty before complex and invasive procedures may have relevance for prognostic and recovery purposes, to optimally inform patients, caregivers and clinicians about perioperative risk and postoperative care needs. The aim of this study was to estimate the prevalence of frailty and describe the associated clinical course and outcomes of patients referred for nonemergent cardiac surgery. METHODS: A prospective cohort of patients aged 50 years and older referred for nonemergent cardiac surgery in Alberta, Canada, from November 2011 to March 2014 were screened preoperatively for frailty, defined as a Clinical Frailty Scale (CFS) score of 5 or greater. Postoperatively, patients were followed by telephone to assess CFS score, health services use and vital status. The primary outcome was all-cause hospital mortality. Secondary outcomes included health services use, hospital discharge disposition, 1-year health-related quality of life and all-cause 5-year mortality. RESULTS: The cohort (n = 529) had a mean age of 67 (standard deviation [SD] 9) years; 25.9% were female, and the prevalence of frailty was 9.6% (n = 51; 95% confidence interval [CI] 7.3%-12.5%). Frail patients were older (median age 75, interquartile range [IQR] 65-80 v. 67, IQR 60-73, yr; p < 0.001), were more likely to be female (51.0% v. 23.2%; p < 0.001), had a higher mean EuroSCORE II (8, SD 3 v. 5, SD 3; p < 0.001) and received combined coronary artery bypass grafting and valve procedures more frequently (29.4% v. 15.9%; p = 0.02) than nonfrail patients. Postoperatively, frail patients had a longer median duration of stay in the cardiovascular intensive care unit (median difference 2.2, 95% CI 1.60-2.79) and hospital (median difference 9.3, 95% CI 8.2-10.3). Hospital mortality was 9.8% among frail patients and 1.0% among nonfrail patients (adjusted hazard ratio 3.84, 95% CI 0.90-16.34). INTERPRETATION: Preoperative frailty was present in 10% of patients and was associated with a higher risk of morbidity and greater health services use. Preoperative frailty has important implications for the postoperative clinical course and resource utilization of patients undergoing cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Fragilidade/epidemiologia , Cardiopatias/epidemiologia , Cardiopatias/cirurgia , Período Pré-Operatório , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Alberta/epidemiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Eletivos , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Avaliação Geriátrica , Cardiopatias/etiologia , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
6.
Biomed Res Int ; 2021: 7302165, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34222484

RESUMO

Infective endocarditis is a sinister condition with considerable morbidity and mortality. Its relevance in the current era is compounded by the increased use of implanted devices such as replacement valves or cardiac implantable electronic devices. These infections are caused by multiple different bacteria with different virulence, pathogenicity, and antimicrobial resistance. Unlike in native endocarditis, the presence of foreign tissue permits sustenance by inflammatory and thrombotic processes as the artificial surfaces promote inflammatory responses and hypercoagulability. Prevention of these infections has been suggested with the use of homografts in combination with antibiotics. Others have attempted to use "low fouling coats" with little clinical success thus far. The use of antibiotic prophylaxis plays a pivotal part in reducing the incidence of prosthesis-related endocarditis. This remains especially crucial with the increasing use of transcatheter heart valve therapies. The widespread use of cardiac implantable electronic devices such as permanent pacemakers, implantable cardioverter defibrillators, and cardiac resynchronization therapy devices has also heralded a noticeable increase in cases of infectious endocarditis affecting complex equipment which can be difficult to treat. Multimodality strategies are needed with input from surgeons and cardiologists to ensure treatment is both prompt and successful, tailored to the individual needs of the patients.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Endocardite/terapia , Cardiopatias/cirurgia , Próteses Valvulares Cardíacas , Marca-Passo Artificial/efeitos adversos , Desenho de Prótese , Infecções Relacionadas à Prótese/etiologia , Animais , Materiais Biocompatíveis , Cardiopatias/terapia , Valvas Cardíacas , Humanos , Inflamação , Implantação de Prótese , Fatores de Risco , Suínos
7.
J Cardiovasc Electrophysiol ; 32(9): 2473-2483, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34270148

RESUMO

INTRODUCTION: In patients with structural heart disease presenting with ventricular tachycardia (VT), detection of ventricular thrombi and subsequent management can be challenging. This study aimed to assess the value of multimodality imaging with cardiac magnetic resonance imaging (CMR), contrast-enhanced transthoracic echocardiography (TTE), and computed tomography (CT) for thrombus detection as well as a management algorithm geared towards anticoagulation and deferred ablation for patients referred for VT ablation. METHODS AND RESULTS: A total of 154 consecutive patients referred for VT ablation underwent preprocedural multimodality imaging with CMR, CT, and TTE. In 9 patients (6%) a new ventricular thrombus was detected and anticoagulation was initiated. Thrombi were detected by CMR in nine patients, by CT in seven patients, and by TTE in two patients. Five patients eventually underwent endocardial VT ablation procedures 6.0 ± 2.0 months after initiation of anticoagulation with one patient also requiring an epicardial approach. Two patients died while on anticoagulation, unrelated to ventricular arrhythmia. Four of five patients were rendered non-inducible and no testing was performed in 1/5 patients. Areas containing left ventricular thrombi were non-excitable with pacing. Six of thirty-two inducible VTs were mapped in close vicinity of ventricular thrombi. No clinical embolic events occurred during the ablation procedures. CONCLUSIONS: Ventricular thrombus was detected in 6% of consecutive patients with structural heart disease undergoing VT ablation. CMR was the most sensitive modality, while contrast-enhanced TTE failed to detect the majority of thrombi. Anticoagulation followed by ablation can be safely and successfully performed in patients with ventricular thrombi.


Assuntos
Ablação por Cateter , Cardiopatias , Taquicardia Ventricular , Ecocardiografia , Cardiopatias/complicações , Cardiopatias/diagnóstico por imagem , Cardiopatias/cirurgia , Humanos , Imageamento por Ressonância Magnética , Taquicardia Ventricular/diagnóstico por imagem , Taquicardia Ventricular/etiologia , Resultado do Tratamento
8.
Zhonghua Fu Chan Ke Za Zhi ; 56(6): 408-417, 2021 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-34154316

RESUMO

Objective: To explore the related factors influencing the length of hospital stay(LOS) of pregnant women with heart disease (PWHD) after cesarean section. Methods: A total of 306 patients with PWHD who underwent cesarean section from January 2012 to March 2019 were collected. Among them, 203 patients had not undergone heart surgery (uncorrected group) and 103 patients who had undergone heart surgery (corrected group) during the same period. Demographic, perioperative and postoperative data were recorded. Predictors associated with postoperative LOS were determined using univariate and multivariate linear regression analysis models. Results: (1) The median LOS after cesarean section in the uncorrected group was 6 days (5-8 days). The results of univariate linear regression analysis showed that 38 parameters had significant impact on LOS (P<0.05). The results of multivariate linear regression analysis showed that 5 parameters were independent risk factors for prolonged LOS in the uncorrected group; among them, the median LOS in uncorrected group with hypertensive disorders of pregnancy was 3 days longer than that in patients with PWHD alone [7 days (5-8 days) vs 4 days (4-5 days), ß=0.195, P=0.001]; the median LOS in uncorrected group with high serum creatinine was 3 days longer than normal patients [7 days (5-13 days) vs 4 days (4-5 days), ß=0.145, P=0.015]; the LOS of patients who chose general anesthesia was 2 days longer than that of patients who chose spinal anesthesia [6 days (4-8 days) vs 4 days (4-5 days), ß=0.154, P=0.007]; the LOS of patients with postoperative pulmonary infection was 4 days longer than that of patients without pulmonary infection [8 days (5-15 days) vs 4 days (4-5 days), ß=0.269, P<0.01]; the LOS of patients who admitted to ICU after surgery was 2 days longer than that not admitted patients [6 days (5-8 days) vs 4 days (4-5 days), ß=0.268, P<0.01]. (2) The median LOS after cesarean section in corrected group was 4 days (4-5 days). The results of univariate linear regression analysis showed that 8 parameters had significant impact on the LOS (all P<0.05). The results of multivariate linear regression analysis showed that 2 parameters, which were American Society of Anesthesiologists (ASA) grade (ß=0.198, P=0.028) and intraoperative blood loss (ß=0.285, P=0.003), were the independent risk factors for prolonged LOS in corrected group. Conclusion: Preoperative with hypertensive disorders of pregnancy, preoperative creatinine increase, intraoperative general anesthesia, postoperative pulmonary infection, and postoperative admission to ICU are independent predictors of prolonged LOS in uncorrected patients with PWHD; ASA classification and intraoperative bleeding are independent predictor of prolonged postoperative LOS in patients with corrected PWHD.


Assuntos
Cesárea , Cardiopatias , Feminino , Cardiopatias/cirurgia , Humanos , Tempo de Internação , Complicações Pós-Operatórias/epidemiologia , Gravidez , Gestantes , Estudos Retrospectivos , Fatores de Risco
9.
Medicine (Baltimore) ; 100(19): e25780, 2021 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-34106611

RESUMO

RATIONALE: Hepatocellular with tumor thrombi extending into 3 hepatic veins (HVs) and right atrium presents as a real clinical challenge. We report the first documented case of surgical resection of an advanced hepatocellular carcinoma (HCC) with extensive invasion to distal stomach, atrium and hepatic vasculatures. PATIENT CONCERNS: We present a case of 48-years old man with abdominal mass accompanying shortness of breath after activities. DIAGNOSES: Preoperative examination revealed giant HCC with tumor thrombi extending into portal vein, HVs, inferior vena cava, and atrium. INTERVENTIONS: Distal stomach involvement was confirmed at surgery and, distal gastrectomy, atrial reconstruction and ante-situm liver resection and autotransplantation under cardio-pulmonary bypass were performed. OUTCOMES: The operation time was 490 minutes, extracorporeal circulation time 124 minutes, and anhepatic time 40 minutes. Postoperative follow-up revealed normal hepatic and cardiac function with no sign of recurrence. LESSONS: This case illustrates that the extensive invasion of HCC to major vasculature and adjacent organs may not necessarily preclude the liver autotransplantation with multi-visceral resection as the treatment option of extremely advanced HCC patients.


Assuntos
Carcinoma Hepatocelular/secundário , Gastrectomia/métodos , Átrios do Coração/cirurgia , Hepatectomia/métodos , Neoplasias Hepáticas/patologia , Transplante de Fígado/métodos , Trombose/etiologia , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico , Carcinoma Hepatocelular/cirurgia , Átrios do Coração/patologia , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Cardiopatias/cirurgia , Veias Hepáticas/patologia , Veias Hepáticas/cirurgia , Humanos , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Veia Porta/patologia , Veia Porta/cirurgia , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/secundário , Neoplasias Gástricas/cirurgia , Trombose/diagnóstico , Trombose/cirurgia , Transplante Autólogo
10.
J Cardiothorac Surg ; 16(1): 164, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099012

RESUMO

BACKGROUND: Intracardiac blood cysts are very rare primary cardiac tumors. Blood cysts originated from the mitral valve represent a minority of cases, and previous cases have been mainly treated with conventional surgery through median sternotomy. When the tumor involves heart valves and histopathological diagnosis remains unknown preoperatively, minimally invasive surgical resection of an intracardiac tumor can be challenging, especially through an endoscopic approach. We herein present the first case of successful surgical resection for a rare mitral valve originated blood cyst in a minimally invasive, totally thoracoscopic approach. CASE PRESENTATION: An apparently healthy 38-year-old male presented to his local hospital with six months history of palpitation and exertional dyspnea. Transthoracic echocardiography showed a mobile round cystic mass inside the left ventricle, attached to the anterolateral papillary muscle and chordae tendineae of the mitral valve. The local doctor diagnosed an intracardiac tumor and suggested a surgical resection through median sternotomy. However, the patient refused to have a sternotomy. He was then referred to us seeking minimally invasive surgery. We assessed the location, appearance and relationship to nearby structures of the tumor with echocardiography, and made a diagnosis of a suspected primary cystic intracardiac tumor. Since we had enough experience of totally endoscopic mitral surgery, our surgical plan was to resect the tumor in the aid of thoracoscopy, and manage the possible deformation and dysfunction of the cardiac structure if necessary. Using femoro-femoral cannulation and cardiopulmonary bypass, we successfully resected the tumor through a thoracoscopic approach in a closed chest, and well preserved the subvalvular structure and valvular function. Postoperative recovery was quick and uneventful. Pathologic diagnosis confirmed a simple blood cyst. CONCLUSIONS: Surgical resection is warranted for symptomatic cases of intracardiac blood cysts. With prudent preoperative diagnosis and comprehensive surgical plan, we believe the thoracoscopic approach is a safe, curative and viable alternative for complete resection of cardiac valvular tumors.


Assuntos
Cistos/cirurgia , Cardiopatias/cirurgia , Valva Mitral/cirurgia , Cirurgia Torácica Vídeoassistida/métodos , Toracoscopia/métodos , Adulto , Cistos/diagnóstico por imagem , Ecocardiografia , Cardiopatias/diagnóstico por imagem , Humanos , Masculino , Valva Mitral/diagnóstico por imagem
12.
Thorac Cardiovasc Surg ; 69(4): 294-307, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34176107

RESUMO

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2020 are analyzed. Under the more than extraordinary conditions of the ongoing worldwide coronavirus disease 2019 pandemic, a total of 161,817 procedures were submitted to the registry. A total of 92,809 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 29,444 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.6:1) was 97.2%. For the 35,469 isolated heart valve procedures, (17,471 transcatheter interventions included), the survival rate was 96.7%. Concerning short- and long-term circulatory support, a total of 2,852 extracorporeal life support/extracorporeal membrane oxygenation implantations, respectively, 843 assist device implantations (left/right/biventricular assist device, total artificial device), were registered. In 2020, the number of isolated heart transplantations increased to 340, a rise of 2.1% compared with the previous year. The isolated lung transplantations amounted to 291, a decrease of 6.4%.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.


Assuntos
COVID-19/epidemiologia , Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/cirurgia , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Sociedades Médicas , Cirurgia Torácica , Comorbidade , Alemanha/epidemiologia , Cardiopatias/epidemiologia , Humanos , Estudos Retrospectivos , Fatores de Risco , SARS-CoV-2
14.
Surgery ; 170(4): 1031-1038, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34148709

RESUMO

BACKGROUND: Familiarity among cardiac surgery team members may be an important contributor to better outcomes and thus serve as a target for enhancing outcomes. METHODS: Adult cardiac surgical procedures (n = 4,445) involving intraoperative providers were evaluated at a tertiary hospital between 2016 and 2020. Team familiarity (mean of prior cardiac surgeries performed by participating surgeon/nonsurgeon pairs within 2 years before the operation) were regressed on cardiopulmonary bypass duration (primary-an intraoperative measure of care efficiency) and postoperative complication outcomes (major morbidity, mortality), adjusting for provider experience, surgeon 2-year case volume before the surgery, case start time, weekday, and perioperative risk factors. The relationship between team familiarity and outcomes was assessed across predicted risk strata. RESULTS: Median (interquartile range) cardiopulmonary bypass duration was 132 (91-192) minutes, and 698 (15.7%) patients developed major postoperative morbidity. The relationship between team familiarity and cardiopulmonary bypass duration significantly differed across predicted risk strata (P = .0001). High (relative to low) team familiarity was associated with reduced cardiopulmonary bypass duration for medium-risk (-24 minutes) and high-risk (-27 minutes) patients. Increasing team familiarity was not significantly associated with the odds of major morbidity and mortality. CONCLUSION: Team familiarity, which was predictive of improved intraoperative efficiency without compromising major postoperative outcomes, may serve as a novel quality improvement target in the setting of cardiac surgery.


Assuntos
Procedimentos Cirúrgicos Cardíacos/ética , Cardiopatias/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Reconhecimento Psicológico , Cirurgiões/ética , Idoso , Procedimentos Cirúrgicos Cardíacos/psicologia , Humanos , Pessoa de Meia-Idade , Morbidade/tendências , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/psicologia , Estudos Retrospectivos , Fatores de Risco , Cirurgiões/psicologia , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia
16.
Ann R Coll Surg Engl ; 103(6): 444-451, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34058117

RESUMO

INTRODUCTION: Despite early enthusiasm, minimally invasive cardiac surgery has had a low uptake compared with novel techniques in interventional cardiology. Steep learning curves from high-volume centres have deterred smaller units from engaging, even though low-volume centres undertake a large proportion of surgical interventions worldwide. We sought to identify the safety and experience of learning minimally invasive cardiac surgery after undertaking a structured fellowship at Blackpool Victoria Hospital, a low-volume centre. MATERIALS AND METHODS: A retrospective analysis of outcomes for all consecutive minimally invasive cardiac surgery procedures performed via a right mini-thoracotomy at our institution between 2007 and 2017 was undertaken. Clinical outcomes included death, conversion to sternotomy, stroke, renal failure and other organ support. Cardiopulmonary bypass, aortic cross-clamp times and learning cumulative sum sequential probability method curves were also assessed to determine how safely the procedure was adopted. RESULTS: A total of 316 patients were operated on for mitral, tricuspid, atrial fibrillation, septal defects or other conditions. The mean logistic European System for Cardiac Operative Risk Evaluation score was 7.0 (± 8.5). Conversion to sternotomy occurred in 12 patients (3.8%) and in-hospital mortality was 7 (2.2%). None of the converted patients died. The learning curves showed an accelerated process of adoption, similar to reference figures from a high-volume German centre. DISCUSSION: It is possible for low-volume cardiac surgical centres to undertake minimally invasive surgical programmes with good outcomes and short learning curves. Despite technical complexities, with a team approach, the learning curve can be navigated safely.


Assuntos
Procedimentos Cirúrgicos Cardíacos/estatística & dados numéricos , Cardiopatias/cirurgia , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/cirurgia , Ponte Cardiopulmonar , Feminino , Defeitos dos Septos Cardíacos/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Mortalidade Hospitalar , Hospitais com Baixo Volume de Atendimentos/organização & administração , Humanos , Curva de Aprendizado , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/estatística & dados numéricos , Duração da Cirurgia , Estudos Retrospectivos , Esternotomia , Toracotomia/métodos , Adulto Jovem
17.
Card Electrophysiol Clin ; 13(2): 357-364, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33990274

RESUMO

The effective diagnosis and management of procedural complications remains an important challenge for electrophysiology operators. Intracardiac echocardiography provides a real-time imaging modality with spectral and color Doppler capabilities that integrates directly with electroanatomic mapping systems. It provides detailed characterization of anatomic variants, which allows the operator to optimize the ablation strategy to the individual thereby avoiding the inherent risk of excessive or ineffective lesions. Complications, such as intracardiac thrombus or pericardial effusion, can be detected and managed before the onset of clinical symptoms. Intracardiac echocardiography facilitates the diagnosis and management of intraoperative hypotension.


Assuntos
Ablação por Cateter/efeitos adversos , Ecocardiografia/métodos , Complicações Intraoperatórias , Cardiopatias/diagnóstico por imagem , Cardiopatias/prevenção & controle , Cardiopatias/cirurgia , Humanos , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/prevenção & controle , Trombose/diagnóstico por imagem , Trombose/prevenção & controle
18.
Am Heart J ; 239: 64-72, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34033804

RESUMO

Background Approximately 20% to 30% of patients awaiting cardiac surgery are anemic. Anemia increases the likelihood of requiring a red cell transfusion and is associated with increased complications, intensive care, and hospital stay following surgery. Iron deficiency is the commonest cause of anemia and preoperative intravenous (IV) iron therapy thus may improve anemia and therefore patient outcome following cardiac surgery. We have initiated the intravenous iron for treatment of anemia before cardiac surgery (ITACS) Trial to test the hypothesis that in patients with anemia awaiting elective cardiac surgery, IV iron will reduce complications, and facilitate recovery after surgery. Methods ITACS is a 1,000 patient, international randomized trial in patients with anemia undergoing elective cardiac surgery. The patients, health care providers, data collectors, and statistician are blinded to whether patients receive IV iron 1,000 mg, or placebo, at 1-26 weeks before their planned date of surgery. The primary endpoint is the number of days alive and at home up to 90 days after surgery. Results To date, ITACS has enrolled 615 patients in 30 hospitals in 9 countries. Patient mean (SD) age is 66 (12) years, 63% are male, with a mean (SD) hemoglobin at baseline of 118 (12) g/L; 40% have evidence (ferritin <100 ng/mL and/or transferrin saturation <25%) suggestive of iron deficiency. Most (59%) patients have undergone coronary artery surgery with or without valve surgery. Conclusions The ITACS Trial will be the largest study yet conducted to ascertain the benefits and risks of IV iron administration in anemic patients awaiting cardiac surgery.


Assuntos
Anemia Ferropriva , Procedimentos Cirúrgicos Cardíacos , Cardiopatias , Ferro , Cuidados Pré-Operatórios/métodos , Administração Intravenosa , Idoso , Anemia Ferropriva/complicações , Anemia Ferropriva/diagnóstico , Anemia Ferropriva/tratamento farmacológico , Anemia Ferropriva/fisiopatologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/classificação , Procedimentos Cirúrgicos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Método Duplo-Cego , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/mortalidade , Feminino , Cardiopatias/sangue , Cardiopatias/complicações , Cardiopatias/cirurgia , Fármacos Hematológicos/administração & dosagem , Fármacos Hematológicos/efeitos adversos , Hemoglobinas/análise , Humanos , Ferro/administração & dosagem , Ferro/efeitos adversos , Masculino , Avaliação de Resultados em Cuidados de Saúde , Projetos de Pesquisa , Medição de Risco
19.
J Pediatr ; 236: 101-107.e3, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34000283

RESUMO

OBJECTIVE: To determine the risk factors for acquiring a respiratory syncytial virus (RSV) and vaccine-preventable infections (R/VPI) in pediatric heart transplant recipients and the associated morbidity and hospital resource use. STUDY DESIGN: Patients <18 years who underwent heart transplantation from September 2003 to December 2018 at hospitals using the Pediatric Health Information System database were identified. Their transplant hospitalization and subsequent hospitalizations for R/VPI through December 2018 were analyzed. Risk factors for R/VPI hospitalizations were evaluated using negative regression binomial models adjusted for demographic and clinical confounders. Total hospital costs were adjusted for 2018 US$. RESULTS: Of 3815 transplant recipients, 681 (17.9%) had an R/VPI hospitalization during 23 746 available person-years of follow-up. There were 984 R/VPIs diagnosed during 951 hospitalizations, and 440 (44.7%) occurred the first year after transplantation. The most common causes were RSV (n = 380; 38.6%), influenza (n = 265; 26.9%), and pneumococcus (n = 105; 10.7%). In adjusted analyses, there was an increased risk of R/VPI hospitalization in patients requiring mechanical circulatory support before transplantation, patients receiving induction with ≥2 immunosuppressive agents, and patients <2 years in the first year after transplantation. The median length of stay for an R/VPI hospitalization was 4 days (IQR, 2-8 days) with a median total cost of $11 081 (IQR, $6215-$24 322). CONCLUSIONS: Hospitalization for R/VPIs occurred frequently after heart transplantation and were associated with significant costs. Potential strategies to minimize R/VPI include expanding vaccine use through accelerated immunization schedules, further studies of use of palivizumab beyond 2 years of age, and immunogenicity monitoring after vaccination with re-immunization based on guidelines.


Assuntos
Cardiopatias/cirurgia , Transplante de Coração , Hospitalização/estatística & dados numéricos , Infecções por Vírus Respiratório Sincicial/epidemiologia , Doenças Preveníveis por Vacina/epidemiologia , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Cardiopatias/diagnóstico , Cardiopatias/etiologia , Custos Hospitalares , Hospitalização/economia , Humanos , Lactente , Recém-Nascido , Masculino , Infecções por Vírus Respiratório Sincicial/economia , Estudos Retrospectivos , Fatores de Risco , Doenças Preveníveis por Vacina/economia
20.
J Cardiothorac Surg ; 16(1): 67, 2021 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-33789704

RESUMO

INTRODUCTION: Cardiac herniation is a rare complication after pulmonary surgery, and there are only a few reports about it. We now report a case of cardiac herniation presenting as superior vena cava obstruction after pneumonectomy. CASE PRESENTATION: A-52-years old woman diagnosed right pulmonary squamous cell carcinoma was carried out right pneumonectomy, the pulmonary artery and right superior pulmonary vein were dissected and ligated intrapericardial. The patient developed tachycardia arrhythmias, hypotension, followed by loss of consciousness at about 18 h after operation. After resuscitation, the patient was conscious but developed cyanosis of the superior vena cava drainage area, uropenia, and hypotension (80/30 mmHg). Bedside-echocardiography showed that the SVC was obstructed due to thrombus formation. Chest radiography a shift of the heart into right hemithorax. Rethoracotomy was performed and the herniated heart was replaced into the pericardium, and the pericardium was repaired with Gore Tex patch. The patient recovered smoothly after the second surgery. CONCLUSION: Cardiac herniation is a rare and fatally complication after thoracic surgery, and the prompt recognition with timely intervention is life-saving. Cardiac herniation is a rare but fatal complication of pneumonectomy. The increasing frequency of surgical resection for locally advanced thoracic carcinoma has led to a renewed emphasis regarding early diagnosis and treatment for cardiac herniation. Here we discuss a case of cardiac herniation presented with acute superior vena cava obstruction syndrome and hemodynamic instability after intrapericradial right pneumonectomy.


Assuntos
Carcinoma de Células Escamosas/cirurgia , Cardiopatias/etiologia , Hérnia/etiologia , Neoplasias Pulmonares/cirurgia , Pneumonectomia/efeitos adversos , Síndrome da Veia Cava Superior/etiologia , Feminino , Cardiopatias/diagnóstico , Cardiopatias/cirurgia , Hérnia/diagnóstico , Herniorrafia , Humanos , Pessoa de Meia-Idade , Pericárdio/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Radiografia Torácica , Síndrome da Veia Cava Superior/cirurgia , Tomografia Computadorizada por Raios X , Veia Cava Superior/cirurgia
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