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Zajonz T, Edinger F, Hofmann J, Yoerueker U, Akintürk H, Markmann M, Müller M. Evaluation of Point-of-Care-Directed Coagulation Management in Pediatric Cardiac Surgery. Thorac Cardiovasc Surg 2024. [PMID: 39137896 DOI: 10.1055/s-0044-1788931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
BACKGROUND Coagulatory alterations are common after pediatric cardiac surgery and can be addressed with point-of-care (POC) coagulation analysis. The aim of the present study is to evaluate a preventive POC-controlled coagulation algorithm in pediatric cardiac surgery. METHODS This single-center, retrospective data analysis included patients younger than 18 years who underwent cardiac surgery with cardiopulmonary bypass (CPB) and received a coagulation therapy according to a predefined POC-controlled coagulation algorithm. Patients were divided into two groups (<10 and >10 kg body weight) because of different CPB priming strategies. RESULTS In total, 173 surgeries with the use of the POC-guided hemostatic therapy were analyzed. In 71% of cases, target parameters were achieved and only in one case primary sternal closure was not possible. Children with a body weight ≤10 kg underwent surgical re-evaluation in 13.2% (15/113), and respectively 6.7% (4/60) in patients >10 kg. Hemorrhage in children ≤10 kg was associated with cyanotic heart defects, deeper intraoperative hypothermia, longer duration of CPB, more complex procedures (RACHS-1 score), and with more intraoperative platelets, and respectively red blood cell concentrate transfusions (all p-values < 0.05). In children ≤10 kg, fibrinogen levels were significantly lower over the 12-hour postoperative period (without revision: 3.1 [2.9-3.3] vs. with revision 2.8 [2.3-3.4]). Hemorrhage in children >10 kg was associated with a longer duration of CPB (p = 0.042), lower preoperative platelets (p = 0.026), and over the 12-hour postoperative period lower platelets (p = 0.002) and fibrinogen (p = 0.05). CONCLUSION The use of a preventive, algorithm-based coagulation therapy with factor concentrates after CPB followed by POC created intraoperative clinical stable coagulation status with a subsequent executable thorax closure, although the presented algorithm in its current form is not superior in the reduction of the re-exploration rate compared to equivalent collectives. Reduced fibrinogen concentrations 12 hours after surgery may be associated with an increased incidence of surgical revisions.
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Affiliation(s)
- Thomas Zajonz
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universität Giessen Fachbereich Medizin, Giessen, Hessen, Germany
| | - Fabian Edinger
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universität Giessen Fachbereich Medizin, Giessen, Hessen, Germany
| | - Johannes Hofmann
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universität Giessen Fachbereich Medizin, Giessen, Hessen, Germany
| | - Uygar Yoerueker
- Department of Childrens Heart Center and Cardiovascular Surgery, Justus Liebig Universität Giessen Fachbereich Medizin, Giessen, Hessen, Germany
| | - Hakan Akintürk
- Department of Childrens Heart Center and Cardiovascular Surgery, Justus Liebig Universität Giessen Fachbereich Medizin, Giessen, Hessen, Germany
| | - Melanie Markmann
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universität Giessen Fachbereich Medizin, Giessen, Hessen, Germany
| | - Matthias Müller
- Department of Anesthesiology, Operative Intensive Care and Pain Medicine, Justus Liebig Universität Giessen Fachbereich Medizin, Giessen, Hessen, Germany
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Durai Samy NK, Taksande K. The Complex Interplay of Variables in Extubation Decision-Making Following Pediatric Cardiac Surgery: A Narrative Review. Cureus 2024; 16:e64216. [PMID: 39130989 PMCID: PMC11315439 DOI: 10.7759/cureus.64216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 07/10/2024] [Indexed: 08/13/2024] Open
Abstract
Pediatric cardiac surgery poses significant challenges in developing countries, where a considerable number of children require intervention for congenital heart disease (CHD). The utilization of endotracheal intubation and anesthesia is pivotal in conducting surgical or angiography procedures on patients with CHD exhibiting diverse anatomical and hemodynamic characteristics. The decision to extubate pediatric patients following cardiac surgery remains a crucial element of postoperative care. This article explores the complexities surrounding extubation decision-making in this population, emphasizing the critical role of surgical, physiological, and postoperative factors. Various preoperative and intraoperative factors influence the timing of extubation. Early extubation is increasingly prevalent, offering benefits like reduced length of stay and minimized drug exposure. Multidisciplinary collaboration and protocol-driven strategies contribute to improved extubation outcomes, emphasizing the need for a comprehensive approach in pediatric cardiac surgery. Future research can focus on the implementation and efficacy of standardized extubation procedures involving collaboration among healthcare experts.
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Affiliation(s)
- Nandha Kumar Durai Samy
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Karuna Taksande
- Anesthesiology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Alzahrani AA, AlAssiri AK, Al-Ebrahim KE, Ganbou ZT, Alsudais MM, Khafagy AM. Impact of Clinical and Sociodemographic Factors on Quality of Life Following Coronary Artery Bypass Grafting: A Mixed-Methods Study. Cureus 2024; 16:e56781. [PMID: 38650792 PMCID: PMC11034901 DOI: 10.7759/cureus.56781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Coronary artery bypass grafting (CABG) is an essential surgical management modality for patients with coronary artery disease. Health-related quality of life (HRQoL) has become important because of the significant decrease in the mortality rate associated with CABG. We aimed to explore the factors that affect the quality of life after CABG. METHODS This study used a descriptive correlational design to assess the determinants of HRQoL using the 36-item Short Form Health Survey questionnaire (SF-36). Patients who underwent CABG at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between March 2015 and December 2021 were enrolled in this study. Overall, 275 participants were eligible for our study, of which 84 were found to be valid for analysis. Phone contacts were made directly with the patient after briefly explaining the study. Scores and clinical data were investigated using multivariable linear regression analysis. RESULTS Subscales of role limitations due to physical issues had the lowest mean scores, followed by vitality and general health (57.4 ± 44.7; 60.4 ± 25.6; 64.1 ± 22.6), respectively. However, social functioning (78.9 ± 29.0) and pain (75.1 ± 29.9) had the highest scores of all subscales. A history of congestive heart failure (CHF) was independently associated with lower scores for physical role limitations (p = 0.021), vitality (p = 0.001), general health (p< 0.001), and mental health (p = 0.011). Lower mental health scores were also predicted by being a widow (p = 0.030), whereas lower general health scores were predicted by being unemployed (p = 0.001) and having a peripheral vascular disease (PVD) (p = 0.043). Additionally, the development of postoperative complications was an independent predictor of lower physical functioning (p = 0.028) and vitality (p = 0.043). Regarding the number of grafts, cardiopulmonary bypass, and cross-clamp time, no significant impact was found on any of the SF-36 subscales (p> 0.05). CONCLUSION The postoperative decline in HRQoL was attributed to comorbidities such as CHF and PVD, postoperative complications including bleeding and wound infection, as well as unemployment and widowed status. Therefore, choosing the appropriate patients for surgery and post-discharge follow-up may enhance HRQoL.
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Affiliation(s)
| | - Abdullah K AlAssiri
- Cardiac Surgery, King Abdulaziz University, Faculty of Medicine, Jeddah, SAU
| | | | - Zeyad T Ganbou
- Cardiac Surgery, King Abdulaziz University Hospital, Jeddah, SAU
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Hanafy DA, Melisa S, Andrianto GA, Suwatri WT, Sugisman. Outcomes of minimally invasive versus conventional sternotomy for redo mitral valve surgery according to Mitral Valve Academic Research Consortium: A systematic review and meta-analysis. Asian J Surg 2024; 47:35-42. [PMID: 37704475 DOI: 10.1016/j.asjsur.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 08/27/2023] [Accepted: 09/01/2023] [Indexed: 09/15/2023] Open
Abstract
A minimally invasive approach through right mini-thoracotomy for redo mitral valve surgery may improve patients' outcomes compared to median sternotomy. This study aims to evaluate the outcomes of both procedures according to the Mitral Valve Academic Research Consortium (MVARC). This systematic review and meta-analysis were performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Literature searching was performed in several databases including PubMed, EBSCOhost, Scopus, and Proquest up to 28 February 2022. Meta-analysis using proportions or means was applied. A total of 13 retrospective cohort articles were included in this study. The incidence of in-hospital mortality (3% vs 9.2%, OR = 0.35; 95% CI: 0.21-0.58; P ≤ 0.0001), reintervention for bleeding (3.8% vs 5.9%, OR = 0.56; 95% CI: 0.32-0.97; P = 0.04), and acute renal failure (5% vs 12%, OR = 0.29; 95% CI: 0.23-0.65; P = 0.0003) was significantly lower in mini-thoracotomy (MINI) group compared to median sternotomy (STER) group. The incidence of neurologic events (3.4% vs 5.5%, OR = 0.66; 95% CI: 0.4-1.08; P = 0.1) and arrhythmia (19.5% vs 25.5%, OR = 0.64; 95% CI: 0.38-1.09; P = 0.1) were also lower in MINI group compared to STER group but was not significant statistically. No significant differences were found in myocardial infarct (1% vs 1%, OR = 0.71; 95% CI: 0.06-8.85; P = 0.79) between MINI and STER group. A minimally invasive surgery through right mini-thoracotomy is associated with a lower incidence of in-hospital mortality, reintervention for bleeding, and acute renal failure. It is a safe alternative to median sternotomy for redo mitral valve surgery.
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Affiliation(s)
- Dudy Arman Hanafy
- Division of Thoracic, Cardiac, and Vascular Surgery, University of Indonesia, Harapan Kita National Heart Center, Jakarta, Indonesia.
| | - Stefanie Melisa
- Division of Thoracic, Cardiac, and Vascular Surgery, University of Indonesia, Harapan Kita National Heart Center, Jakarta, Indonesia
| | - Galih Asa Andrianto
- Division of Thoracic, Cardiac, and Vascular Surgery, University of Indonesia, Harapan Kita National Heart Center, Jakarta, Indonesia
| | - Widya Trianita Suwatri
- Division of Thoracic, Cardiac, and Vascular Surgery, University of Indonesia, Harapan Kita National Heart Center, Jakarta, Indonesia
| | - Sugisman
- Division of Thoracic, Cardiac, and Vascular Surgery, University of Indonesia, Harapan Kita National Heart Center, Jakarta, Indonesia
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Malik MI, Jae JC, Sefein OSS, Zamper RPC, Nagpal AD. Radical mediastinal lipectomy for tamponade-like cardiac physiology. J Cardiothorac Surg 2023; 18:338. [PMID: 37990270 PMCID: PMC10664668 DOI: 10.1186/s13019-023-02421-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND Re-opening the chest is an unwanted and potentially morbid complication after open heart surgery, most commonly required for refractory bleeding or tamponade. In this report, we present a unique case of a postoperative coronary artery bypass patient, demonstrating clinical features of cardiac tamponade of the right atrium and ventricle with inconclusive findings on imaging. CASE PRESENTATION A 62 year-old male presented to hospital with exertional angina and a coronary angiogram found severe three-vessel coronary artery disease with preserved left ventricular function. He underwent an uncomplicated triple coronary artery bypass surgery. Over the following hours in the cardiac intensive care unit, the patient had a climbing serum lactate level and increasing vasopressor requirements. On investigations, there was evidence of compression of the right heart. The patient was taken back to the operating room where very little clot or bleeding was identified, rather there was significant amounts of mediastinal fat surrounding the heart which was subsequently resected with wide margins. The patient had complete resolution of their symptoms and an uncomplicated postoperative course thereafter. CONCLUSIONS To our knowledge, this case is the first reported occurrence of cardiac constriction from excessive mediastinal fat after open heart surgery. Identifying patients at high-risk for excessive pericardial fat, as well as considering alternative modalities of imaging appear to be the main stay in diagnosis at this point. Current treatment is a mediastinal lipectomy with wide margins, avoiding injury to surrounding structures such as the phrenic nerve and innominate vein. Future study might consider the value of prophylactic mediastinal lipectomy at time of surgery, and methods to improve detection with current and future imaging modalities.
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Affiliation(s)
- Mohsyn Imran Malik
- Division of Cardiac Surgery, London Health Science Centre/Western University, Suite B6-104, 339 Windermere Rd, London, ON, N6A 5A5, Canada
| | - James Changhyun Jae
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre/Western University, London, ON, Canada
- Critical Care Western, London Health Sciences Centre/Western University, London, ON, Canada
| | - Osama Sedky Shehata Sefein
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre/Western University, London, ON, Canada
- Critical Care Western, London Health Sciences Centre/Western University, London, ON, Canada
| | - Raffael Pereira Cezar Zamper
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre/Western University, London, ON, Canada
| | - A Dave Nagpal
- Division of Cardiac Surgery, London Health Science Centre/Western University, Suite B6-104, 339 Windermere Rd, London, ON, N6A 5A5, Canada.
- Critical Care Western, London Health Sciences Centre/Western University, London, ON, Canada.
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Al-Ebrahim KE, Albishri SA, Alotaibi SW, Alsayegh LA, Almufarriji EM, Babader RB, Abdulgader SA, Alsaegh AA, Alghamdi RS, Elassal AA. The Quality of Life in Patients With Valve Prosthesis After Undergoing Surgery for Valvular Heart Diseases. Cureus 2023; 15:e43030. [PMID: 37674938 PMCID: PMC10479721 DOI: 10.7759/cureus.43030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/08/2023] Open
Abstract
Background and objective Surgery for valvular heart disease by valve replacement procedures has become one of the most frequently performed cardiac operations to improve the quality of life (QoL). Its long-term outcomes are assessed using the quality-of-life index (QLI). This study aimed to evaluate the QoL in patients who received valve prostheses after surgery for valvular heart diseases at King Abdulaziz University in Jeddah from 2010 to 2023. Methods This was a descriptive cross-sectional study of 59 patients aged 18 years or older who underwent surgical mitral and aortic valve replacement, involving either mechanical or tissue valves, from January 2010 to May 2023 They were selected using a non-probability convenient sampling technique. Their medical records were reviewed and the participants were interviewed via phone using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which was used to measure the QoL of patients (https://neurotoolkit.com/whoqol-bref/). Results The study found that the QoL of the participants varied across different domains. The psychological domain had the highest mean score of 79.76, while the physical domain had the lowest mean score of 61.5. The other domains, - social, environmental, and spiritual - had mean scores of 68.05, 69.9, and 73.25, respectively. There was a statistically significant association between the QoL and nationality and chronic diseases. However, the duration after surgery and the type of valve did not significantly correlate with the QoL in the different domains. Conclusion Based on our findings, heart valve replacement improves the QoL of patients. Healthcare organizations and providers should aim to improve the management of chronic diseases to optimize outcomes.
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Affiliation(s)
- Khalid E Al-Ebrahim
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Shomokh A Albishri
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Sarah W Alotaibi
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Lama A Alsayegh
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Ebtesam M Almufarriji
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Raghad B Babader
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Shahad A Abdulgader
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Alaa A Alsaegh
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
| | - Rami S Alghamdi
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
- Department of Cardiac Surgery, King Abdullah Medical City, Makkah, SAU
| | - Ahmed A Elassal
- Cardiac Surgery Unit, Department of Surgery, King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, SAU
- Department of Cardiothoracic Surgery, Zagazig University, Zagazig, EGY
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Pearl RG, Cole SP. Development of the Modern Cardiothoracic Intensive Care Unit and Current Management. Crit Care Clin 2023; 39:559-576. [PMID: 37230556 DOI: 10.1016/j.ccc.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The modern cardiothoracic intensive care unit (CTICU) developed as a result of advances in critical care, cardiology, and cardiac surgery. Patients undergoing cardiac surgery today are sicker, frailer, and have more complex cardiac and noncardiac morbidities. CTICU providers need to understand postoperative implications of different surgical procedures, complications that can occur in CTICU patients, resuscitation protocols for cardiac arrest, and diagnostic and therapeutic interventions such as transesophageal echocardiography and mechanical circulatory support. Optimum CTICU care requires a multidisciplinary team with collaboration between cardiac surgeons and critical care physicians with training and experience in the care of CTICU patients.
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Affiliation(s)
- Ronald G Pearl
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford University School of Medicine, 300 Pasteur Drive, Room H3589.
| | - Sheela Pai Cole
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford University School of Medicine, 300 Pasteur Drive, Room H3589
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Spadaccio C, Rose D, Nenna A, Taylor R, Bittar MN. Early Re-Exploration versus Conservative Management for Postoperative Bleeding in Stable Patients after Coronary Artery Bypass Grafting: A Propensity Matched Study. J Clin Med 2023; 12:jcm12093327. [PMID: 37176767 PMCID: PMC10179715 DOI: 10.3390/jcm12093327] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/17/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Postoperative bleeding requiring re-exploration in cardiac surgery has been associated with complications impacting short-term outcomes and perioperative survival. Many aspects of decision-making for re-exploration still remain controversial, especially in hemodynamically stable patients with significant but not acutely cumulating chest drain output. We investigated the impact of re-exploratory surgery on short-term outcomes in a "borderline population" of CABG patients who experienced significant non-acute bleeding, but that were not in critically hemodynamic unstable conditions. METHODS A prospectively collected database of 8287 patients undergoing primary isolated elective CABG was retrospectively interrogated. A population of hemodynamically stable patients experiencing significant non-acute or rapidly cumulating bleeding (>1000 mL of blood loss in 12 h, <200 mL per hour in the first 5 h) with normal platelet and coagulation tests was identified (N = 1642). Patients belonging to this group were re-explored (N = 252) or treated conservatively (N = 1390) based on the decision of the consultant surgeon. Clinical outcomes according to the decision-making strategy were compared using a propensity score matching (PSM) approach. RESULTS After PSM, reoperated patients exhibited significantly higher overall blood product consumption (88.4% vs. 52.6% for red packed cells, p = 0.001). The reoperated group experienced higher rates of respiratory complications (odds ratio 5.8 [4.29-7.86] with p = 0.001 for prolonged ventilation), prolonged stay in intensive care unit (coefficient 1.66 [0.64-2.67] with p = 0.001) and overall length of stay in hospital (coefficient 2.16 [0.42-3.91] with p = 0.015) when compared to conservative management. Reoperated patients had significantly increased risk of multiorgan failure (odds ratio 4.59 [1.37-15.42] with p = 0.014) and a trend towards increased perioperative mortality (odds ratio 3.12 [1.08-8.99] with p = 0.035). CONCLUSIONS Conservative management in hemodynamically stable patients experiencing significant but non-critical or emergency bleeding might be a safe and viable option and might be advantageous in terms of reduction of postoperative morbidities and hospital stay.
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Affiliation(s)
- Cristiano Spadaccio
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
| | - David Rose
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
| | - Antonio Nenna
- Cardiovascular Surgery, Università Campus Bio-Medico di Roma, 00128 Rome, Italy
| | - Rebecca Taylor
- Research and Development, Blackpool Teaching Hospitals, Blackpool FY3 8NR, UK
| | - Mohamad Nidal Bittar
- Cardiothoracic Surgery, Lancashire Cardiac Center, Blackpool Victoria Hospital, Blackpool FY3 8NR, UK
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Alamri HM, Alotaibi TO, Alghatani AA, Alharthy TF, Sufyani AM, Alharthi AM, Mahmoud AA, Almahdi MK, Alama N, Al-Ebrahim KE. Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG). Cureus 2023; 15:e37717. [PMID: 37206527 PMCID: PMC10191450 DOI: 10.7759/cureus.37717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
INTRODUCTION The study assessed coronary artery bypass grafting (CABG) postoperative outcomes and associated factors in Saudi male and female patients. This was a retrospective cohort of patients who underwent CABG at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2015 to December 2022. Results: We included 392 patients, of whom 63 (16.1%) were female. Female undergoing CABG were significantly older (p=0.0001), had a significantly higher incidence of diabetes (p=0.0001), obesity (p=0.001), hypertension (p=0.001), and congestive heart failure (p=0.005), with a smaller body surface area (BSA) (p=0.0001) than male. Though renal dysfunction, previous cerebrovascular accident/transient ischemic attack (CVA/TIA), and myocardial infarction (MI), incidences were similar in both genders. Females were at significantly higher risk of mortality (p=0.0001), longer hospital stay (p=0.0001), and prolonged ventilation (p=0.0001). Preoperative renal dysfunction was the only statistically significant predictor of postoperative complications (p=0.0001). Female gender and preoperative renal dysfunction, were significant independent predictors of postoperative mortality and prolonged ventilation (p=0.005). CONCLUSION This study's findings indicated that females have worse CABG outcomes and a higher risk of morbidities and complications. Uniquely our study showed a higher incidence of prolonged ventilation in females postoperatively.
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Affiliation(s)
- Hassan M Alamri
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Turki O Alotaibi
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | - Tariq F Alharthy
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Albaraa M Sufyani
- Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, SAU
| | | | | | | | - Nabil Alama
- Medicine, King Abdulaziz University Hospital, Jeddah, SAU
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Bartoszko J, Martinez-Perez S, Callum J, Karkouti K, Farouh ME, Scales DC, Heddle NM, Crowther M, Rao V, Hucke HP, Carroll J, Grewal D, Brar S, Brussières J, Grocott H, Harle C, Pavenski K, Rochon A, Saha T, Shepherd L, Syed S, Tran D, Wong D, Zeller M. Impact of cardiopulmonary bypass duration on efficacy of fibrinogen replacement with cryoprecipitate compared with fibrinogen concentrate: a post hoc analysis of the Fibrinogen Replenishment in Surgery (FIBRES) randomised controlled trial. Br J Anaesth 2022; 129:294-307. [DOI: 10.1016/j.bja.2022.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 11/28/2022] Open
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Moldovan H, Antoniac I, Gheorghiță D, Safta MS, Preda S, Broască M, Badilă E, Fronea O, Scafa-Udrişte A, Cacoveanu M, Molnar A, Costache VS, Zaharia O. Biomaterials as Haemostatic Agents in Cardiovascular Surgery: Review of Current Situation and Future Trends. Polymers (Basel) 2022; 14:1189. [PMID: 35335519 PMCID: PMC8955858 DOI: 10.3390/polym14061189] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 02/04/2023] Open
Abstract
Intraoperative haemostasis is of paramount importance in the practice of cardiovascular surgery. Over the past 70 years, topical haemostatic methods have advanced significantly and today we deal with various haemostatic agents with different properties and different mechanisms of action. The particularity of coagulation mechanisms after extracorporeal circulation, has encouraged the introduction of new types of topic agents to achieve haemostasis, where conventional methods prove their limits. These products have an important role in cardiac, as well as in vascular, surgery, mainly in major vascular procedures, like aortic dissections and aortic aneurysms. This article presents those agents used for topical application and the mechanism of haemostasis and offers general recommendations for their use in the operating room.
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Affiliation(s)
- Horațiu Moldovan
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Iulian Antoniac
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania;
| | - Daniela Gheorghiță
- Faculty of Materials Science and Engineering, Politehnica University of Bucharest, 060042 Bucharest, Romania;
| | - Maria Sabina Safta
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Silvia Preda
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Marian Broască
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
| | - Elisabeta Badilă
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Oana Fronea
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Alexandru Scafa-Udrişte
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
| | - Mihai Cacoveanu
- Department of Cardiovascular Surgery, Bucharest Clinical Emergency Hospital, 014461 Bucharest, Romania; (M.S.S.); (S.P.); (M.B.); (A.S.-U.); (M.C.)
| | - Adrian Molnar
- Faculty of Medicine, Iuliu Hateganu University of Medicine and Pharmacy, 400000 Cluj-Napoca, Romania;
- Heart Institute, 400001 Cluj-Napoca, Romania
| | - Victor Sebastian Costache
- Sf. Constantin Hospital, 500388 Brasov, Romania;
- Faculty of Medicine, Titu Maiorescu University, 040441 Bucharest, Romania
| | - Ondin Zaharia
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (E.B.); (O.F.); (O.Z.)
- Prof.Dr. Theodor Burghele Clinical Hospital, 050659 Bucharest, Romania
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