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1.
J Extra Corpor Technol ; 53(2): 137-139, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34194080

RESUMO

Little is reported in the literature regarding hereditary spherocytosis (HS) and cardiopulmonary bypass (CPB). We present a case of a 19-month-old girl child who was referred for an atrioventricular septal defect (AVSD) and HS. The patient underwent surgical repair, and an exchange transfusion was performed at the initiation of CPB. No significant hemolysis or events attributed to HS were observed during or after CPB. The surgical repair of an AVSD in a pediatric patient with HS and total volume exchange transfusion is herein reported.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Defeitos dos Septos Cardíacos , Esferocitose Hereditária , Ponte Cardiopulmonar , Criança , Transfusão Total , Feminino , Humanos , Lactente , Esferocitose Hereditária/complicações , Esferocitose Hereditária/cirurgia
2.
J Extra Corpor Technol ; 53(2): 140-145, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34194081

RESUMO

Blood-primed cardiopulmonary bypass circuits are frequently necessary to achieve safe support during pediatric open-heart surgery. Literature is lacking regarding suitable prime constituents or methods for achieving a physiologically appropriate blood-primed circuit. We examined the chemistry and hematology of neonatal blood-primed circuits from the conclusion of the priming procedure until the initiation of bypass. Base deficit/excess, pH, pO2, pCO2, HCO3, glucose, sodium, potassium, calcium, hematocrit, lactate, and osmolality were analyzed. Any deviation over time from the original prime value was compared for significance. Statistically significant changes were found between T0 and all time points for all parameters, except for pH and pO2 out to 1 hour. Among all parameters, various rates of change were observed. Although most changes in the parameters were found to be statistically significant, those changes may not be clinically significant based on clinician interpretation. Attention to the prime quality beyond the immediate post-priming period may be beneficial. Should the time period between validation of the prime quality and initiation of bypass be extended, it may be advisable to reevaluate the prime quality.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Criança , Máquina Coração-Pulmão , Hematócrito , Humanos , Recém-Nascido
3.
Curr Cardiol Rep ; 23(8): 101, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196837

RESUMO

PURPOSE OF REVIEW: The contribution of continuous flow left ventricular assist devices (c-LVAD) to vasoplegic syndrome and postoperative outcomes after orthotopic heart transplant (OHT) is contested in the literature. A standardized definition of vasoplegic syndrome (VS) is needed to better recognize and manage vasoplegic shock. RECENT FINDINGS: Vasoplegic syndrome occurs after orthotopic heart transplant more frequently than after other surgeries requiring cardiopulmonary bypass. c-LVADs lead to small vessel endothelial dysfunction and desensitized adrenal receptors; however, their contribution to the development of vasoplegia is debated in clinical studies. Pulsatility may mitigate vascular dysfunction resulting from long-term continuous flow, and should be further explored in the clinical setting when considering risk factors for vasoplegic syndrome. The incidence of vasoplegic syndrome after orthotopic heart transplant is rising with the increasing use of c-LVAD bridge to therapy. Robust clinical studies are needed to advance our understanding and approach to mitigating VS after OHT.


Assuntos
Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Vasoplegia , Ponte Cardiopulmonar , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Transplante de Coração/efeitos adversos , Coração Auxiliar/efeitos adversos , Humanos , Estudos Retrospectivos , Fatores de Risco , Vasoplegia/tratamento farmacológico , Vasoplegia/etiologia
4.
J Cardiothorac Surg ; 16(1): 162, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34099011

RESUMO

INTRODUCTION: Multiple studies have shown a decrease in the inflammatory response with minimized bypass circuits leading to less complications and mortality rate. On the other hand, some other studies showed that there is no difference in post-operative outcomes. So, the aim of this study is to investigate the clinical benefits of using the Minimized cardiopulmonary Bypass system in Coronary Artery Bypass Grafting and its effect on postoperative morbidity and mortality in diabetic patients as one of the high-risk groups that may benefit from these systems. METHODS: This is a retrospective study that included 114 diabetic patients who underwent Coronary artery bypass grafting (67 patients with conventional cardiopulmonary bypass system and 47 with Minimized cardiopulmonary bypass system). The patients' demographics, intra-operative characteristics and postoperative complications were compared between the two groups. RESULTS: Coronary artery bypass grafting was done on a beating heart less commonly in the conventional cardiopulmonary bypass group (44.78% vs. 63.83%, p = 0.045). There was no difference between the two groups in blood loss or transfusion requirements. Four patients in the conventional cardiopulmonary bypass group suffered perioperative myocardial infarction while no one had perioperative myocardial infarction in the Minimized cardiopulmonary bypass group. On the other hand, less patients in the conventional group had postoperative Atrial Fibrillation (4.55% vs. 27.5%, p = 0.001). The requirements for Adrenaline and Nor-Adrenaline infusions were more common the conventional group than the Minimized group. CONCLUSION: The use of conventional cardiopulmonary bypass for Coronary Artery Bypass Grafting in diabetic patients was associated with higher use of postoperative vasogenic and inotropic support. However, that did not translate into higher complications rate or mortality.


Assuntos
Ponte Cardiopulmonar/métodos , Ponte de Artéria Coronária/métodos , Doença da Artéria Coronariana/cirurgia , Complicações do Diabetes/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Adulto , Idoso , Doença da Artéria Coronariana/complicações , Feminino , Humanos , Complicações Intraoperatórias/epidemiologia , Complicações Intraoperatórias/etiologia , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
5.
Am J Case Rep ; 22: e930890, 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34143764

RESUMO

BACKGROUND Cardiac vasoplegic syndrome is a form of vasodilatory shock characterized by profound vasodilation and low systemic vascular resistance, which results in significant hypotension despite high cardiac output and appropriate fluid resuscitation. In up to 45% of patients, cardiopulmonary bypass (CPB) can precipitate vasoplegic syndrome. Vasoplegic syndrome after CPB that is refractory to other vasopressors, such as catecholamine and vasopressin, has been successfully treated with inhibitors of the nitric oxide (NO) system, such as methylene blue and hydroxocobalamin. Methylene blue has been the treatment of choice because of its effectiveness for both prevention and rescue therapy. Hydroxocobalamin has demonstrated efficacy in combination with methylene blue, and also on its own when vasoplegic syndrome is refractory to methylene blue. CASE REPORT We present 2 cases that expand upon the existing evidence supporting the efficacy of hydroxocobalamin as a first-line option for inhibiting the NO system in vasoplegic syndrome that is refractory to other vasopressors. Specifically, we demonstrate the appropriate and successful use of hydroxocobalamin alone to treat refractory vasoplegic syndrome after CPB. CONCLUSIONS Refractory vasoplegic syndrome that occurs after CPB has been successfully treated with inhibitors of the NO system, such as methylene blue and hydroxocobalamin. The present cases expand upon the scant existing evidence of the efficacy of hydroxocobalamin as an appropriate option for refractory vasoplegic syndrome.


Assuntos
Hipotensão , Vasoplegia , Ponte Cardiopulmonar/efeitos adversos , Humanos , Hidroxocobalamina/uso terapêutico , Azul de Metileno/uso terapêutico , Vasoplegia/tratamento farmacológico , Vasoplegia/etiologia
6.
Kyobu Geka ; 74(6): 407-412, 2021 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-34059581

RESUMO

A shaggy aorta with a mobile atheromatous plaque in a thoracic lesion is considered a risk factor for cerebral infarction during aortic arch surgery. The brain isolation technique was introduced to prevent embolic stroke either by manipulating the severely atheromatous aorta, or by producing a sandblasting effect using the arterial jet in cardiopulmonary bypass. We performed total arch replacement with the aid of a brain isolation technique in four patients with aortic arch aneurysm complicated with a shaggy aorta between 2016 and 2020. Antegrade selective cerebral perfusion was established prior to systemic perfusion of the cardiopulmonary bypass. Total arch replacement using the frozen elephant technique was performed in all patients. There was no operative mortality, and all patients were discharged without major neurological complications. Therefore, the brain isolation technique could be a useful adjunctive method to prevent embolic stroke in patients who undergo total arch replacement for aortic arch aneurysm with a shaggy aorta.


Assuntos
Aorta Torácica , Aneurisma Aórtico , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Encéfalo , Ponte Cardiopulmonar , Humanos , Perfusão
7.
Georgian Med News ; (313): 158-162, 2021 Apr.
Artigo em Russo | MEDLINE | ID: mdl-34103449

RESUMO

Research in recent years has shown that pulsating flow during cardiopulmonary bypass can prevent the development of a number of perfusion complications inherent in continuous blood flow. On the other hand, attempts to pulsate with roller and centrifugal pumps, which are structurally DC pumps, are fraught with complications. However, these pumps are clinically tested and are successfully used for the implementation of direct blood flow. The aim of the study was to develop and create a preclinical apparatus that transforms the flow of DC pumps into a pulsating one. We have developed an electronically controlled device (pulsator) that transforms the direct blood flow generated by roller or centrifugal pumps into a pulsating flow synchronized by the cardiogram. The pulsator was tested on the bench in various load modes. Cardiosynchronized pulsating blood flow with circulatory support is able to effectively relieve the ventricular myocardium both in volume and pressure. The pulsator can be easily and easily installed on the operating table or on the perfusion device stand. The ability to control the pulsation frequency, systolic-diastolic duration, clear cardiosynchronization and the ability to control the onset and termination of the impulse can provide unloading of the myocardium in volume and pressure in experiments on animals in the mode of auxiliary circulation.


Assuntos
Ponte Cardiopulmonar , Hemodinâmica , Animais , Ventrículos do Coração , Perfusão , Fluxo Pulsátil
8.
J Card Surg ; 36(8): 2729-2734, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34018257

RESUMO

INTRODUCTION: Vasoplegia denotes a state of low tissue perfusion characterized by hypotension, tachycardia, and low systemic vascular resistance. This state results in increased mortality and morbidity following cardiac surgery. A better understanding of the associated risk factors will guide the surgical team in patient management. The aim of this study is to determine which risk factors are involved in its emergence. METHODS: This prospective observational study included adult cardiac surgery patients between February - September 2018 at a single cardiothoracic surgery center. Patients were evaluated for cardiac contractility, surgical drainage, inotrope, and vasopressor requirement perioperatively. The groups were compared for demographic, echocardiographic, and operative variables. Variables significant in univariate analysis were carried on to binary logistic regression for risk factor analysis. RESULTS: A total of 31 patients were vasoplegic among a total of 487 included patients, resulting in a 6.37% incidence. In the vasoplegia group, chronic kidney failure, use of angiotensin-converting enzyme (ACE) inhibitors, use of angiotensin receptor blockers, and use of diuretics were more frequent, cardiopulmonary bypass (CPB) and aortic cross-clamp durations were longer, and mean Euroscore II was higher. Vasoplegia was more frequent in valve surgery and resternotomy patients. CPB duration, use of ACE inhibitors, use of angiotensin receptor blockers, and chronic renal failure were independent risk factors. CONCLUSION: Patients with long CPB duration, preoperative use of ACE inhibitors or Angiotensin receptor blockers, and a history of renal failure requiring dialysis are under increased risk of vasoplegia. Vasoplegia necessitates large-scale studies for a better understanding of its risk factors.


Assuntos
Procedimentos Cirúrgicos Cardíacos , Vasoplegia , Adulto , Ponte Cardiopulmonar/efeitos adversos , Ponte de Artéria Coronária , Humanos , Fatores de Risco , Vasoplegia/epidemiologia , Vasoplegia/etiologia
9.
Int J Cardiol ; 336: 47-53, 2021 08 01.
Artigo em Inglês | MEDLINE | ID: mdl-33965470

RESUMO

BACKGROUND: Amongst children with congenital heart disease (CHD), earlier age of repair improves cardiovascular outcomes. The effects of early intervention on neurodevelopment remains unclear. We assessed the association between early life repair, cardiopulmonary bypass (CPB) and the incidence of neurocognitive disorders (NCD) amongst CHD patients. METHODS: We created two retrospective cohorts from the Quebec CHD Database; with data from 1988 to 2010. Complexity of reparative procedures for CHD lesions were used as the proxy of CPB exposure with more complex procedure means longer exposure to CPB. Study Population 1 included pediatric patients with a single reparative procedure and compared patients with complex (long CBP) versus isolated shunt (short CBP) lesions. To assess the effects of CPB alone in Study Population 2 we compared patients with isolated atrial septal defects (ASD) who had surgical (short CBP) versus percutaneous (no CBP) repairs. The primary endpoint for both cohorts was development of an NCD. RESULTS: In Study population 1, 1174 patients underwent complex surgical repair and 1620 had a shunt closure. The incidence of NCDs was 2.45/100 person-years in the complex surgery group, and 2.08/100 person-years in the shunt closure group. The following were associated with increased risk of developing a NCD: surgical complexity (Hazard Ratio [HR] = 1.20, 95% Confidence Interval [CI]: 1.01-1.42), younger age at intervention (AAI) (HR = 1.20, 95% CI: 1.16-1.25), male sex (HR = 1.91, 95% CI: 1.61-2.27), and later calendar year at intervention (HR = 1.06, 95% CI: 1.04-1.07). Study population 2 had 527 isolated ASD patients; 202 underwent surgical repair and 325 had percutaneous closure. The incidence of NCDs was not statistically different between groups. Male sex (HR = 1.77, 95% CI: 1.08-2.89) and younger AAI (HR = 1.15, 95% CI: 1.06-1.25) were associated with increased NCD risk. CONCLUSION: Increased surgical complexity, male sex and younger AAI were associated with increased risk of NCDs in pediatric CHD patients. Surveillance protocols should be considered to identify NCDs in CHD patients after cardiac intervention.


Assuntos
Cardiopatias Congênitas , Ponte Cardiopulmonar , Criança , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/epidemiologia , Cardiopatias Congênitas/cirurgia , Humanos , Masculino , Transtornos Neurocognitivos , Quebeque/epidemiologia , Estudos Retrospectivos
10.
J Cardiothorac Surg ; 16(1): 135, 2021 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-34001213

RESUMO

BACKGROUND: It's necessary to analyze the related risk factors and complications of low cardiac output syndrome (LCOS) after operation in children with congenital heart disease (CHD), to elucidate the management strategy of LCOS. METHODS: CHD children admitted to the department of cardiology in our hospital from January 15, 2019 to October 31, 2020 were included. The personal and clinical data of CHD children with LCOS and without LCOS were collected and compared. Logistic regression analyses were conducted to identify the risk factors of postoperative LCOS. Besides, the complication and mortality of LCOS and no LCOS patients were compared. RESULTS: A total of 283 CHD patients were included, the incidence of postoperative LCOS in CHD patients was 12.37%. There were significant differences in the age, preoperative oxygen saturation, two-way ventricular shunt, duration of CPB and postoperative residual shunt between two groups (all p < 0.05). Logistic regression analyses indicated that age ≤ 4y(OR2.426, 95%CI1.044 ~ 4.149), preoperative oxygen saturation ≤ 93%(OR2.175, 95%CI1.182 ~ 5.033), two-way ventricular shunt (OR3.994, 95%CI1.247 ~ 6.797), duration of CPB ≥ 60 min(OR2.172, 95%CI1.002 ~ 4.309), postoperative residual shunt (OR1.487, 95%CI1.093 ~ 2.383) were the independent risk factors of LCOS in patients with CHD (all p < 0.05). There were significant differences in the acute liver injury, acute kidney injury, pulmonary infection, tracheotomy, duration of mechanical ventilation, length of ICU stay and mortality (all p < 0.05), no significant difference in the 24 h drainage was found(p = 0.095). CONCLUSION: LCOS after CHD is common, more attentions should be paid to those patients with age ≤ 4y, preoperative oxygen saturation ≤ 93%, two-way ventricular shunt, duration of CPB ≥ 60 min, postoperative residual shunt to improve the prognosis of CHD patients.


Assuntos
Baixo Débito Cardíaco/etiologia , Ponte Cardiopulmonar/efeitos adversos , Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/etiologia , Injúria Renal Aguda/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Masculino , Período Pós-Operatório , Prognóstico , Análise de Regressão , Respiração Artificial/efeitos adversos , Fatores de Risco
11.
J Cardiothorac Surg ; 16(1): 142, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030698

RESUMO

BACKGROUND: Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation. METHODS: Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke's Cognitive Examination Revised Test before and 30 days after surgical procedure. RESULTS: A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677-10.60, p = 0.027). Addenbrooke's Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001). CONCLUSION: There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. TRIAL REGISTRY NUMBER: clinicaltrials.gov , NCT02697786 14.


Assuntos
Disfunção Cognitiva/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Embolia Intracraniana/etiologia , Esternotomia/efeitos adversos , Toracotomia/efeitos adversos , Fatores Etários , Idoso , Valva Aórtica/cirurgia , Ponte Cardiopulmonar/efeitos adversos , Estudos de Coortes , Estudos Transversais , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Embolia Intracraniana/diagnóstico por imagem , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Estudos Prospectivos , Esternotomia/métodos , Toracotomia/métodos , Fatores de Tempo , Ultrassonografia Doppler
12.
Cardiol Young ; 31(5): 699-706, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33942711

RESUMO

BACKGROUND: Paediatric cardiac surgery on cardiopulmonary bypass induces substantial physiologic changes that contribute to post-operative morbidity and mortality. Fluid overload and oedema are prevalent complications, routinely treated with diuretics. The optimal diuretic choice, timing of initiation, dose, and interval remain largely unknown. METHODS: To guide clinical practice and future studies, we used PubMed and EMBASE to systematically review the existing literature of clinical trials involving diuretics following cardiac surgery from 2000 to 2020 in children aged 0-18 years. Studies were assessed by two reviewers to ensure that they met eligibility criteria. RESULTS: We identified nine studies of 430 children across four medication classes. Five studies were retrospective, and four were prospective, two of which included randomisation. All were single centre. There were five primary endpoints - urine output, acute kidney injury, fluid balance, change in serum bicarbonate level, and required dose of diuretic. Included studies showed early post-operative diuretic resistance, suggesting higher initial doses. Two studies of ethacrynic acid showed increased urine output and lower diuretic requirement compared to furosemide. Children receiving peritoneal dialysis were less likely to develop fluid overload than those receiving furosemide. Chlorothiazide, acetazolamide, and tolvaptan demonstrated potential benefit as adjuncts to traditional diuretic regimens. CONCLUSIONS: Early diuretic resistance is seen in children following cardiopulmonary bypass. Ethacrynic acid appears superior to furosemide. Adjunct diuretic therapies may provide additional benefit. Study populations were heterogeneous and endpoints varied. Standardised, validated endpoints and pragmatic trial designs may allow investigators to determine the optimal diuretic, timing of initiation, dose, and interval to improve post-operative outcomes.


Assuntos
Diuréticos , Cardiopatias Congênitas , Ponte Cardiopulmonar , Criança , Diuréticos/uso terapêutico , Cardiopatias Congênitas/cirurgia , Humanos , Estudos Prospectivos , Estudos Retrospectivos
13.
J Cardiothorac Surg ; 16(1): 136, 2021 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-34016147

RESUMO

BACKGROUND: Cardiac fibromas are rare benign cardiac neoplasms, most frequently occurring in the pediatric population; with very rare cases identified in adults. The tumors are comprised of spindled cells with myofibroblastic ultrastructural features embedded in generally collagenous and elastic stroma. The tumors are intramural in the ventricles, most commonly the left ventricle. Clinical symptoms vary by location and size of tumor and some are asymptomatic. Surgical resection is curative, but rare cases require cardiac transplantation. CASE PRESENTATION: We report an asymptomatic, large, right ventricular fibroma in a 64-year-old woman. The patient underwent open incisional tumor biopsy via lower hemi-sternotomy, followed by complete tumor resection via full sternotomy a week later after confirming the tumor is benign. The tumor was resected using cardiopulmonary bypass, and the defect of right ventricular free wall was repaired using a prosthetic double-patch technique. The postoperative course was uneventful. The patient was discharged to home on day 4 post-complete tumor resection. CONCLUSION: This report expands the existing literature for better comprehension and detection of cardiac fibroma patients and also highlights the various imaging modalities, surgical management, and histological analysis.


Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Fibroma/cirurgia , Neoplasias Cardíacas/cirurgia , Ponte Cardiopulmonar , Feminino , Fibroma/diagnóstico , Neoplasias Cardíacas/diagnóstico , Ventrículos do Coração/cirurgia , Humanos , Pessoa de Meia-Idade , Esternotomia
14.
Kyobu Geka ; 74(2): 139-141, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33976021

RESUMO

The patient was a 76-year-old man with myasthenia gravis (MG). He suffered from a sudden back pain, and was diagnosed with Stanford type A acute aortic dissection. We performed emergency graft replacement of the ascending aorta under cardiopulmonary bypass with hypothermic circulatory arrest. A neuromuscular blocking agent was administered only once at tracheal intubation. The operation was completed without incident. A neuromuscular antagonist was administered once just after the operation. Fifteen hours after the operation, the tracheal tube was extubated. His postoperative course was uneventful and he has been well for three years since the operation. This is a very rare surgical case report of acute aortic dissection with MG.


Assuntos
Aneurisma Dissecante , Miastenia Gravis , Idoso , Aneurisma Dissecante/complicações , Aneurisma Dissecante/diagnóstico por imagem , Aneurisma Dissecante/cirurgia , Aorta , Ponte Cardiopulmonar , Emergências , Humanos , Masculino , Miastenia Gravis/complicações
16.
J Pak Med Assoc ; 71(2(B)): 704-707, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33941963

RESUMO

OBJECTIVE: To assess different anaesthesia-related quality indicators during adult cardiac surgery. METHODS: The prospective clinical audit was conducted at the Aga Khan University Hospital, Karachi, from October 2016 to March 2017, and comprised all adult patients scheduled for cardiac surgery. Different anaesthesia-related quality indicators were observed during the pre-induction phase, before the cardiopulmonary bypass, during the procedure, and post-surgery till the transfer from the operating room to the cardiac intensive care unit. Data was analysed using SPSS 19. RESULTS: Of the 264 patients, 217(82.2%) had complete record; 160(73.7%) males and 57(26.3%) females. The overall mean age was 56.56±12.46 years. In the pre-induction phase, difficult intravenous and invasive line access was seen in 42(19.3%) patients. Inappropriate information in the preoperative form was found in 6(2.8%) patients, and preoperative drugs for anxiolysis were used in 145(66.8%) patients. Haemodynamic issues were significant during the surgery in 15(6.9%) patients. In the post-surgery period, abnormal activated clotting time was found in 17(7.8%) patients, while monitoring problems were faced in 7(3.2%) cases during transfer to cardiac intensive care unit. CONCLUSIONS: It will help to develop quality improvement policies to enhance patient safety, satisfaction and better outcome.


Assuntos
Anestesia em Procedimentos Cardíacos , Anestesia , Procedimentos Cirúrgicos Cardíacos , Adulto , Idoso , Ponte Cardiopulmonar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
17.
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
18.
Gene ; 790: 145690, 2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-33961973

RESUMO

OBJECTIVE: During extracorporeal circulation, blood is in contact with nonendothelial surfaces. The increase in the amount of blood touching the non-endothelial surface increases the damage to the blood elements. This initiates and increases oxidative stress. Increased oxidative stress leads to the activation of antioxidant systems. These two systems work gradually in the process of Cardiopulmonary Bypass. This study aims to investigate the changes of TNF-α, Nrf2 and HO-1 gene expression in extracorporeal circulation. MATERIALS AND METHODS: Fifteen patients who underwent open heart surgery were included in the study. Blood samples were taken preoperatively, during cardiopulmonary bypass (CPB) and 24 hours postoperatively. TNF-α, Nrf2 and HO-1 gene expressions in plasma samples were studied by using appropriate kits. Changes in gene expressions were compared. RESULTS: TNF-α gene expression increased during CPB compared to preoperative levels (p <0.05). Similarly, Nrf-2 gene expression increased significantly during CPB (p <0.001) and decreased postoperatively (p <0.001). There was a significant increase in HO-1 gene expression during CPB (p <0.01). Postoperatively, this increase was found to decrease similar to Nrf2 (p <0.05). CONCLUSIONS: According to the results, TNF-α, Nrf2, HO-1 gene expressions increase during CPB and these values decrease after the operation. This shows that oxidative stress and inflammatory processes start with CPB and antioxidant processes start similarly. With the termination of CPB, both processes are terminated. This has been demonstrated by gene expressions. Future studies will make it easier to understand these processes.


Assuntos
Ponte Cardiopulmonar/métodos , Doenças Cardiovasculares/metabolismo , Regulação da Expressão Gênica , Heme Oxigenase-1/metabolismo , Fator 2 Relacionado a NF-E2/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Doenças Cardiovasculares/genética , Doenças Cardiovasculares/patologia , Doenças Cardiovasculares/cirurgia , Feminino , Heme Oxigenase-1/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fator 2 Relacionado a NF-E2/genética , Estudos Prospectivos , Fator de Necrose Tumoral alfa/genética
19.
BMC Res Notes ; 14(1): 201, 2021 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-34022969

RESUMO

OBJECTIVE: Fast-track cardiac anesthesia (FTCA) is a technique that may improve patient access to surgery and maximize workforce utilization. However, feasibility and factors impacting FTCA implementation remain poorly explored both locally and internationally. We describe the specific intraoperative and postoperative protocols for our FTCA program, assess protocol compliance and identify reasons for FTCA failure. RESULTS: We tested the program in 16 patients undergoing elective cardiac surgery requiring cardiopulmonary bypass. There was 100% compliance with the FTCA protocols. Four (25%) patients successfully completed the FTCA protocol (extubated < 4 h postoperatively and discharged from the intensive care unit on the same operative day).


Assuntos
Anestesia , Procedimentos Cirúrgicos Cardíacos , Ponte Cardiopulmonar , Hospitais de Ensino , Humanos , Tempo de Internação , Melhoria de Qualidade
20.
J Card Surg ; 36(7): 2575-2577, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33955054

RESUMO

A congenital left ventricular aneurysm is very rare. Clinical presentation varies from absence of symptoms to ventricular arrhythmias, heart failure or even sudden death. The optimal management is controversial and the surgical technique is not defined. A left ventricular aneurysm was diagnosed on prenatal echocardiography at 33 weeks gestation. After birth, initial transthoracic echocardiography confirmed the diagnosis. Two months later, the infant was taken to surgery for aneurysm repair using the Dor procedure with cardiopulmonary bypass. This technique eliminates the need for external prosthetic materials and produces a more physiologic left ventricular geometry. Transthoracic echocardiography performed at 6-month follow-up showed an ejection fraction of 66%.


Assuntos
Aneurisma Cardíaco , Insuficiência Cardíaca , Ponte Cardiopulmonar , Ecocardiografia , Aneurisma Cardíaco/diagnóstico por imagem , Aneurisma Cardíaco/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Lactente
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