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Cardiovascular Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Cardiac surgery is an effective treatment for ischaemic heart disease and valve disease, relieving symptomatic angina and prolonging survival in selected patient groups. Standard indications for coronary artery bypass surgery include left main stem or triple vessel coronary artery disease, particularly in patients with diabetes and/or LV dysfunction where there is prognostic benefit. Surgery is offered for severe heart valve disease providing specific criteria are met, with either repair or replacement with bioprosthetic or mechanical valves. Surgical treatments for severe HF include cardiac transplantation or LV assist device implantation for eligible patients. Patients with complex congenital heart disease frequently require surgical correction.
Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
This can occur 1–2 weeks after cardiac surgery, most often after CABG and mitral valve replacement. The most common symptoms are new/worsening pericardial effusions, pleuritic chest pain, and fever with raised inflammatory markers. Its features are identical to Dressler's syndrome following myocardial infarction. Surgical trauma and cardiopulmonary bypass trigger the systemic inflammatory response, with antiheart autoantigen release and the deposition of immune complexes in the pericardium thereby provoking the occurrence of PPS. Conservative treatment is associated with a higher recovery rate. Therapeutic options for the refractory cases are long-term oral corticoids or pericardiectomy. Cardiac tamponade or constriction develops in 0.1–6% of patients requiring surgery. Coronary artery and bypass graft occlusion, unstable angina and persistent pericardial pain have been described. The majority of patients respond to anti-inflammatory agents, and only a small proportion require pericardial drainage or pericardiectomy.
Anesthesia for Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Ti Lian Kah, Sophia Ang Bee Leng, Wei Zhang, Lalitha Manickam, Jai Ajitchandra Sule
Since the 1960s, the development of cardiac anesthesia has supported the advances made in cardiac surgery practice based on necessity (Figure 5.1). With the advance of minimally invasive cardiac surgery, new challenges emerge in the development of cardiac anesthesia to facilitate the various operations this entails [1]. This chapter will focus on anesthesia for minimal-incision non-robotic cardiac surgery with and without CPB in adult heart surgery (Figures 5.2, 5.3 and 5.4).
Daytime variation in non-cardiac surgery impacts the recovery after general anesthesia
Published in Annals of Medicine, 2023
Feng Xu, Qingtong Zhang, Dongsheng Xuan, Shuai Zhao, Yafeng Wang, Linlin Han, Shiqian Huang, Hongyu Zhu, Tingting Wang, Xiangdong Chen
Likewise, another retrospective cohort study included 9734 patients who had aortic valve, mitral valve, and/or coronary artery bypass graft surgery and also described that there was no difference in mortality and cardiac complications between morning and afternoon cardiac surgeries [23]. The reasons for inconsistencies between other studies and our results were as follows. Firstly, due to the small number of patients undergoing cardiac surgery, our study only included non-cardiac surgeries. Secondly, our topics only focused on the clinically protective effect of daytime variation on recovery after anesthesia instead of mortality or cardiac complications. Finally, these recent clinical trials and retrospective studies presented disputed conclusions about daytime variation in the cardioprotective effect of the afternoon compared with morning surgery. Considering the controversy about daytime variation in the cardioprotective effect, we excluded cardiac surgeries, reducing their potential impacts and capturing more accuracy in our results.
Surgical versus medical treatment for infective endocarditis in patients on dialysis: a systematic review and meta-analysis
Published in Renal Failure, 2022
Sze-Wen Ting, Jia-Jin Chen, Tao-Han Lee, George Kuo
Another challenge is that the volume of cardiac surgery in each study hospital may be associated with different outcomes. The mortality rate after cardiac surgery in general and pediatric populations is closely linked to the surgery volume of the hospital [27–31]. This volume–outcome relationship may be linked to several factors, including the experience of the surgeons, anesthesiologists, and postoperative care team, as well as equipment maintenance [32–34]. However, during our review, hospital and surgery volume information were unavailable in all studies. Although the cardiac surgery volume of each study hospital may be retrieved indirectly from the Internet, such information would be unobtainable for nationwide databases or international registries [16,18]. Therefore, the outcomes could not be adjusted for surgery volume.
Validation for EuroSCORE II in the Indonesian cardiac surgical population: a retrospective, multicenter study
Published in Expert Review of Cardiovascular Therapy, 2022
Juni Kurniawaty, Budi Yuli Setianto, Yunita Widyastuti, Supomo Supomo, Cindy E Boom, Cornelia Ancilla
Open heart surgery procedures are showing an increasing trend in Indonesia. There was a 22.31% increase in open-heart surgery procedures between 2015 and 2016 [1]. Cardiac surgery procedures have been considered one of the most expensive surgical procedures. Perioperative complications are not uncommon in cardiac surgery and can increase the cost significantly, especially in high-risk surgical procedures. Risk stratification may reduce the risk of complications in these patients. The rationale is, that when faced with a patient with a high risk of mortality, we should anticipate and make preparations to prevent complications and improve outcomes. Risk stratification is important in the management of cardiac surgery patients. Risk stratification may be associated with better surgical outcomes, and it also allows us to improve the quality of care and make comparisons of outcomes [2].