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Deaths Following Cardiac Surgery and Invasive Interventions
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Reporting the outcomes of cardiac surgical procedures to hospitals and providers is increasingly common. However, whether to release cardiac surgical outcomes to the public is a matter of debate. An important consideration in both private and public release of report cards is accuracy of risk adjustment to account for case-mix differences between hospitals. Specifically, tertiary or quaternary referral centres may provide surgery to patients at high risk of death, whereas other centres’ case-mixes may, overall, be lower risk. The Society of Cardiothoracic Surgeons have been publishing outcomes for procedures and individual hospital and surgeons since 2005. General operative mortality ranged from 2% to 3% for all procedures. Cardiac failure with shock is the leading cause of death. Recent autopsy data is lacking.
Cardiac diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Saravanan Kuppuswamy, Sudarshan Balla
Certain patients with heart disease may develop refractory symptoms during pregnancy that necessitate cardiac surgical procedures. In some cases, surgery may be lifesaving for the mother, albeit resulting in increased fetal mortality. The outcome of cardiovascular surgery performed during pregnancy is affected by numerous variables, such as the indication, maternal condition, the timing of the surgery relative to the duration of the pregnancy, the interval between admission and surgery, and the use of duration of cardiopulmonary bypass. These factors should be reviewed with the patient on an individual basis.
Critical care, neurology and analgesia
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Single fentanyl doses (1–3 mcg/kg) attenuate haemodynamic reactions during intubation [138], and infusion (0.5–2.5 mcg/kg/h) reduces physiological and behavioural measures of pain and stress during mechanical ventilation in neonates [139–141] and infants [138]. Fentanyl (1.5–3 mcg/kg) is suitable for procedural pain because of its rapid onset of action and short duration of effect [119,142], but respiratory depression may occur [143,144]. Bolus administration of 10–75 mcg/kg for cardiac surgical procedures results in minimal adverse cardiovascular effects [125,145,146]. Oral transmucosal fentanyl (5–15 mcg/kg) provides consistent analgesia for brief painful procedures after 15–20 min or as anaesthetic pre-medication, but can be associated with vomiting and desaturation [147,148]. Fentanyl (0.25–2 mcg/ml) is commonly added to local anaesthetic epidural infusions to improve analgesic quality.
Efficacy of Topical Hemostatic Agents: A Comparative Evaluation of Two Gelatin/Thrombin-Based Hemostatic Matrices in a Porcine Kidney Surgical Model
Published in Journal of Investigative Surgery, 2019
Paul Slezak, Philipp Heher, Xavier Monforte, Claudia Keibl, Heinz Redl, Daniel Spazierer, Heinz Gulle
This study was performed in standardized lesions in one organ to ensure high consistency and high sensitivity for measuring differences between the two hemostatic agents. These conditions would not be achievable in clinical settings. A further strength of the study was the accurate assessment of bleeding, which can be difficult to achieve in clinical trials. A potential limitation of this pre-clinical study is that it does not account for factors resulting from inter-individual differences co-morbidities or use of anticoagulant medications as found in clinical patients. To cover such aspects a clinical study would be advisable. This is especially relevant in cardiac surgical procedures where heparinization is commonly performed, which may lead to additional bleeding-related complications.
COVID-19 pandemic and its impact on service provision: A cardiology prospect
Published in Acta Cardiologica, 2021
Sana Adam, Syeda Anum Zahra, Cheryl Yan Ting Chor, Yuti Khare, Amer Harky
Surgical procedures for patients with structural heart disease (SHD) have also been affected. The guidance issued by the Centre for Medicare and Medicaid Services(CMS) in the United States has recommended limiting cardiac surgical procedures to 'highly symptomatic patients' [30]. As a result, a number of [31]aortic valve replacement surgeries for low-risk patients have been delayed. Tanguturi et al. have suggested that patients with aortic stenosis should be monitored via virtual assessments every 1–3 months to assess disease progression and treatment should be delayed until the pandemic subsides [32]. However, the risk of delaying treatment should be balanced against the risk of patient exposure to infection and current resource limitations[33].
Improved health-related quality of life in patients 6 and 12 months after surgical aortic valve replacement
Published in Scandinavian Cardiovascular Journal, 2022
Riikka Henttunen, Mika Kohonen, Jari Laurikka
Surgery provides relief from the hemodynamic constraint. The evaluation of the results of aortic valve replacement surgery often focuses on specific outcomes. Many studies have focused on differences between biological and mechanical prosthetic valves and studied mortality, morbidity, number of re-operations, and bleeding complications [2], but the patient quality of life has been less often the main outcome in these evaluations. The number of elderly people in open heart surgery increases [3]. In elderly people, cardiac surgical procedures affect less the life expectancy or the risk of future morbidity, but the relief of symptoms and improved overall functional capacity may be of more value to the patient [4].