Deaths Following Cardiac Surgery and Invasive Interventions
Mary N. Sheppard in 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.
Healthcare Politics and Policy in America
Kant Patel, Mark Rushefsky in Healthcare Politics and Policy in America, 2019
The report then goes on to look at the traditional ways that healthcare markets fail, thus requiring government action to correct poor markets, and finds all of those criticisms to be wanting. Interestingly, the report argues, as do others (see, for example, Silver and Hyman 2018), that current health insurance policies provide poor incentives to both providers and patients. The third-party insurance system is administratively complex, and it provides incentives for patients to consume as much healthcare as possible (including low-value healthcare) and providers to provide as much healthcare as possible because they make more money for providing more services (even those of limited value). The report, and others, argues that insurance should only cover high-cost, unpredictable health needs (such as open-heart surgery) rather than everything, including the predictable (such as well-baby checkups). The report compares the situation to auto insurance, where insurance does not cover gas or routine maintenance (such as oil changes) but does cover most of the costs in the event of an accident. The report critiques the tax expenditure for employer-sponsored insurance for helping to cover the low-cost and predictable events. While the report takes a comprehensive look at the healthcare system, such as mergers, graduate medical education, and foreign-trained physicians, the basic reform proposed is competition.
Dysphagia associated with head and neck cancer
Margaret Walshe, Maggie-Lee Huckabee in Clinical Cases in Dysphagia, 2018
The patient reported that he was due for admission for elective cardiac thoracic surgery for an aortic valve replacement. Given the known history of silent aspiration, careful attention was paid to provide full and detailed handover to the speech and language therapy team at the cardiothoracic centre to ensure that the patient could be closely monitored during his postoperative recovery. The cardiac surgery was postponed in the first instance due to a further episode of pneumonia, and then due to a fall, which resulted in a fracture of the cervical spine. The spinal injury was managed at his local general hospital so, again, due diligence was required to provide accurate reports about swallowing status to the managing medical and speech and language therapy team. The patient was seen by the speech and language therapy team at the local hospital where thickened fluids were recommended in the absence of instrumental evaluation. This differing approach to dysphagia management may reflect the lack of experience of the local speech and language therapy team in managing HNC caseloads. Due to the cervical spine fracture, the patient required a neck brace for a number of months and he felt that the reduced mobility resulted in deterioration in swallowing function. All dysphagia rehabilitation exercises were discontinued. The cardiac surgery was undertaken almost six months later than initially scheduled. The postoperative course was complicated by a complete heart block requiring a pacemaker and a prolonged inpatient stay.
Transesophageal echocardiography–associated gastrointestinal injuries: systematic review and pooled rates of gastrointestinal injuries
Published in Baylor University Medical Center Proceedings, 2023
Manesh Kumar Gangwani, Abeer Aziz, Dushyant Singh Dahiya, Rehmat Ullah Awan, Muhammad Aziz, Anooja Rani, Amir Humza Sohail, Hazim Hakmi, Hassam Ali, Umar Hayat, Wade Lee-Smith, Faisal Kamal, Sumant Inamdar
GI bleeding was considered present when there was clinically evident bleeding directly attributed to the TEE procedure or a decrease in hemoglobin levels by two points, necessitating a blood transfusion. Lacerations referred to injuries involving the mucosa or deeper layers of the GI tract, while perforation indicated a reported interruption in the GI tract as observed during esophagogastroduodenoscopy (EGD). Catheter-based interventions encompassed interventional cardiology procedures that utilized TEE as an assistance for percutaneous, catheter-based treatments. Cardiac surgery was defined as any surgical procedure employed to treat cardiac diseases. Critically ill patients were defined as individuals with significant diseases who were admitted to the intensive care unit of a hospital. Liver problems included cirrhosis and liver failure, as defined by the authors or indicated by the need for transplantation.
Effects of remote ischemic preconditioning on platelet activation and reactivity in patients undergoing cardiac surgery using cardiopulmonary bypass: a randomized controlled trial
Published in Platelets, 2022
Youn Joung Cho, Karam Nam, Sol Ji Yoo, Seohee Lee, Jinyoung Bae, Ji-Young Park, Hang-Rae Kim, Tae Kyong Kim, Yunseok Jeon
Eligible patients were adult patients (age >18 years) who were scheduled for cardiac surgery using CPB at Seoul National University Hospital. Cardiac surgery included cardiac valve surgery, aorta replacement, intracardiac mass excision, and combined surgical procedures, using CPB. Patients were excluded if they met any of the following criteria: preoperative left ventricular ejection fraction <30% or receipt of mechanical ventricular support; presence of peripheral vascular disease or poorly controlled diabetes; use of non-steroidal anti-inflammatory drugs within 3 days, intravenous heparin within 6 h, low-molecular-weight heparin within 24 h, or platelet inhibitors within 24 h prior to surgery; known thrombocytopenia or platelet dysfunction; end-stage renal disease or requirement for hemodialysis; active infectious disease; pregnancy; or refusal to participate (Figure 1).
Safety and feasibility of same-day discharge after elective percutaneous balloon mitral valvotomy: a prospective, single-center registry in India
Published in Acta Cardiologica, 2021
Sharad Chandra, Abhishek Gupta, Gaurav Chaudhary, VS Narain, SK Dwivedi, Rishi Sethi, Akshyaya Pradhan, Pravesh Vishwakarma, Akhil Sharma, Monika Bhandari, Salvatore Cassese
This is a single-centre registry performed at the Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India. Between January 2018 and November 2018 all patients admitted at our institution with severe MV stenosis were screened for possible enrolment in the registry. Patients above the age of 12 years were included in the registry if they had: (a) severe symptomatic (New York Heart Association – NYHA class II–IV) MV stenosis; (b) MV stenosis suitable for elective PBMV; or (c) history of restenosis after previous PBMV (pending anatomical suitability for repeat elective PBMV). Patients were excluded if they had: (a) mild MV stenosis; (b) pre-procedural more than mild MV regurgitation; (c) other significant concomitant valvular disease (except secondary tricuspid regurgitation); (d) decompensated congestive heart failure; (e) atrial flutter/fibrillation; (f) indication to oral anticoagulants due to other comorbid conditions; (g) clot in left atrium or left atrial appendage; (h) need for cardiac surgery due to other cardiac disease; or (i) pregnancy (supposed or planned).
Related Knowledge Centers
- Congenital Heart Defect
- Coronary Artery Bypass Surgery
- Coronary Artery Disease
- Endocarditis
- Rheumatic Fever
- Surgery
- Heart
- Great Vessels
- Surgeon
- Valvular Heart Disease