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Patris V, Giakoumidakis K, Argiriou M, Naka KK, Apostolakis E, Field M, Kuduvalli M, Oo A, Siminelakis S. Factors associated with early cardiac complications following transcatheter aortic valve implantation with transapical approach. Pragmat Obs Res 2018; 9:21-27. [PMID: 30022864 PMCID: PMC6044350 DOI: 10.2147/por.s157843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To estimate the incidence of postprocedural early cardiac complications among patients undergoing transcatheter aortic valve implantation, through transapical approach (TA-TAVI), and to identify factors independently associated with the occurrence of them. Patients and methods A retrospective cohort study of 90 patients, who had undergone TA-TAVI in a tertiary hospital of Liverpool, UK, during a 5-year period (September 2008–October 2013), was conducted. Data on patient demographics, periprocedural characteristics and cardiac complications presented within 30-day post TA-TAVI were collected, retrospectively, using the hospital’s electronic database. Results The overall 30-day incidence of cardiac complications was estimated at 18.9% (n=17/90). The rate of new onset of atrial fibrillation (AF), atrioventricular block requiring permanent pacemaker implantation, shockable cardiac arrest rhythm and cardiac tamponade was 11.1%, 3.3%, 2.2% and 2.2%, respectively. Bivariate analysis found that absence of preoperative AF (p=0.01), receiving of oral inotropes preprocedurally (p=0.01), intravenous inotropic support postprocedurally (p=0.01) and requirement for postprocedural tracheal intubation (p=0.001) were the main factors associated with increased probability for patient cardiac morbidity. Conclusion It seems that patients with absence of AF and oral inotropic support preprocedurally and those with post TA-TAVI mechanical ventilatory and intravenous inotropic support have greater probability to develop cardiac complications. This knowledge allows the early identification of high-risk patients and supports clinicians to apply both preventive and therapeutic interventions for the optimum patient management and care. In addition, administrators could allocate the health care system resources effectively.
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Affiliation(s)
- Vasileios Patris
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece,
| | | | - Mihalis Argiriou
- Department of Cardiac Surgery, "Evangelismos" General Hospital of Athens, Athens, Greece,
| | - Katerina K Naka
- Department of Cardiology, Medical School, University of Ioannina, Ioannina, Greece
| | | | - Mark Field
- Department of Cardiothoracic Surgery, Heart and Chest Hospital of Liverpool, Liverpool, UK
| | - Manoj Kuduvalli
- Department of Cardiothoracic Surgery, Heart and Chest Hospital of Liverpool, Liverpool, UK
| | - Aung Oo
- Department of Cardiothoracic Surgery, Heart and Chest Hospital of Liverpool, Liverpool, UK
| | - Stavros Siminelakis
- Department of Cardiothoracic Surgery, University of Ioannina, Ioannina, Greece
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Meziane M, Koundi A, Meskine A, Bensghir M, Hatim A, Ahtil R, Ait Houssa M, Boulahya A, Haimeur C, Drissi M. [Predictors of prolonged ICU stay following elective adult cardiac surgery: Monocentric retrospective study on 5 and half years]. Ann Cardiol Angeiol (Paris) 2017; 66:66-73. [PMID: 28129899 DOI: 10.1016/j.ancard.2016.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 12/08/2016] [Indexed: 11/17/2022]
Abstract
AIM The aim of our study was to identify predictors for prolonged ICU stay following elective adult cardiac surgery under cardiopulmonary bypass. PATIENTS AND METHODS A retrospective study was conducted during 5 years and a half period. Were included, patients age≥18 years old, underwent elective cardiac surgery under cardiopulmonary bypass. Patients who died within 48hours of surgery were excluded. Prolonged ICU stay was defined as stay in the ICU for 48hours or more. RESULTS During the review period, 610 patients were included. One hundred and sixty-four patients have required a prolonged ICU stay (26.9 %). In multivariate analysis, 5 predictors were identified: ejection fraction<30 % (OR 19.991, IC 95 % [1.382-289.1], P=0.028], pulmonary hypertension (OR 2.293, IC 95 % [1.058-4.973], P=0.036), prolonged ventilation (≥12hours) (OR 4.026, IC 95 % [2.407-6.733], P<0.001). Number of blood units transfused (OR 1.568, IC 95 % [1.073-2.291], and postoperative acute renal failure (OR 2.620, IC 95 % [1.026-6.690], P=0.044]. Prolonged ICU stay is significantly associated with prolonged hospital stay (17 days vs 13 days ; P<0.001) and higher in hospital mortality (22 % vs. 3 %, P<0.001). CONCLUSION The identification of these patients at risk of prolonged ICU stay is crucial. It will aid to plan prophylactic measures to optimize their support.
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Affiliation(s)
- M Meziane
- Pôle d'anesthésie-réanimation, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc.
| | - A Koundi
- Pôle d'anesthésie-réanimation, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - A Meskine
- Pôle d'anesthésie-réanimation, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - M Bensghir
- Pôle d'anesthésie-réanimation, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - A Hatim
- Service de réanimation de chirurgie cardiaque, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - R Ahtil
- Pôle d'anesthésie-réanimation, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - M Ait Houssa
- Service de chirurgie cardiaque, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - A Boulahya
- Service de chirurgie cardiaque, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - C Haimeur
- Pôle d'anesthésie-réanimation, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
| | - M Drissi
- Service de réanimation de chirurgie cardiaque, hôpital militaire Mohammed V, 10100 Rabat, Maroc; Hôpital Militaire d'instruction Mohammed, 10100 Rabat, Maroc; Faculté de médicine et de pharmacie, Souissi, 10100 Rabat, Maroc; Université Mohammed V, Souissi, 10100 Rabat, Maroc
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Coulson T, Bailey M, Reid C, Tran L, Mullany D, Parker J, Hicks P, Pilcher D. Acute risk change (ARC) identifies outlier institutions in perioperative cardiac surgical care when the standardized mortality ratio cannot. Br J Anaesth 2016; 117:164-71. [DOI: 10.1093/bja/aew180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2016] [Indexed: 11/12/2022] Open
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Almashrafi A, Elmontsri M, Aylin P. Systematic review of factors influencing length of stay in ICU after adult cardiac surgery. BMC Health Serv Res 2016; 16:318. [PMID: 27473872 PMCID: PMC4966741 DOI: 10.1186/s12913-016-1591-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 07/27/2016] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU) care is associated with costly and often scarce resources. In many parts of the world, ICUs are being perceived as major bottlenecks limiting downstream services such as operating theatres. There are many clinical, surgical and contextual factors that influence length of stay. Knowing these factors can facilitate resource planning. However, the extent at which this knowledge is put into practice remains unclear. The aim of this systematic review was to identify factors that impact the duration of ICU stay after cardiac surgery and to explore evidence on the link between understanding these factors and patient and resource management. METHODS We conducted electronic searches of Embase, PubMed, ISI Web of Knowledge, Medline and Google Scholar, and reference lists for eligible studies. RESULTS Twenty-nine papers fulfilled inclusion criteria. We recognised two types of objectives for identifying influential factors of ICU length of stay (LOS) among the reviewed studies. These were general descriptions of predictors and prediction of prolonged ICU stay through statistical models. Among studies with prediction models, only two studies have reported their implementation. Factors most commonly associated with increased ICU LOS included increased age, atrial fibrillation/ arrhythmia, chronic obstructive pulmonary disease (COPD), low ejection fraction, renal failure/ dysfunction and non-elective surgery status. CONCLUSION Cardiac ICUs are major bottlenecks in many hospitals around the world. Efforts to optimise resources should be linked to patient and surgical characteristics. More research is needed to integrate patient and surgical factors into ICU resource planning.
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Affiliation(s)
- Ahmed Almashrafi
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Mustafa Elmontsri
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Paul Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, Charing Cross Campus, Reynolds Building, St Dunstans Road, London, W6 8RP UK
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Zhou L, Ma J, Gao J, Chen S, Bao J. Optimizing Prophylactic Antibiotic Practice for Cardiothoracic Surgery by Pharmacists' Effects. Medicine (Baltimore) 2016; 95:e2753. [PMID: 26945362 PMCID: PMC4782846 DOI: 10.1097/md.0000000000002753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Pharmacists' role may be ideal for improving rationality of drug prescribing practice. We aimed to study the impact of multifaceted pharmacist interventions on antibiotic prophylaxis in patients undergoing clean or clean-contaminated operations in cardiothoracic department. A pre-test-post-test quasiexperimental study was conducted in a cardiothoracic ward at a tertiary teaching hospital in Suzhou, China. Patients admitted to the ward were collected as baseline group (2011.7-2012.12) and intervention group (2013.7-2014.12), respectively. The criteria of prophylaxis antibiotic utilization were established on the basis of the published guidelines and official documents. During the intervention phase, a dedicated pharmacist was assigned and multifaceted interventions were implemented in the ward. Then we compared the differences in antibiotic utilization, bacterial resistance, clinical and economic outcomes between the 2 groups. Furthermore, patients were collected after the intervention (2015.1-2015.6) to evaluate the sustained effects of pharmacist interventions. 412 and 551 patients were included in the baseline and intervention groups, while 156 patients in postintervention group, respectively. Compared with baseline group, a significant increase was found in the proportion of antibiotic prophylaxis, the proportion of rational antibiotic selection, the proportion of suitable prophylactic antibiotic duration, and the proportion of suitable timing of administration of the first preoperative dose (P < 0.001). Meanwhile, a significant reduction was seen in the rate of unnecessary replacement of antibiotics and the rate of unnecessary combinations (P < 0.001). Besides, pharmacist intervention resulted in favorable outcomes with significantly decreased rates of surgical site infections, prophylactic antibiotic cost, and significantly shortened length of stay (P < 0.05). Furthermore, there were also significant decreases of the rates of antibiotic resistant enterobacter cloacae, klebsiella pneumonia, and staphylococcus aureus (P < 0.05). Moreover, the effects were sustained after discontinuation of the active interventions, as shown in prophylactic antibiotic utilization data. Pharmacist interventions in cardiothoracic surgery result in a high adherence to evidence-based treatment guidelines and a profound culture change in drug prescribing with favorable outcomes. The effects of pharmacist intervention are sustained and the role of pharmacists is emphasized for rational medication and optimal outcomes in clinical treatment.
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Affiliation(s)
- Ling Zhou
- From the Department of Pharmacy, The First Affiliated Hospital, School of Medicine, Soochow University, Suzhou, China
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Zeriouh M, Sabashnikov A, Choi YH, Fatullayev J, Reuter H, Popov AF, Langebartels G, Kimmig L, Rahmanian PB, Wittwer T, Neef K, Wippermann J, Wahlers T. A novel treatment strategy of new onset atrial fibrillation after cardiac surgery: an observational prospective study. J Cardiothorac Surg 2014; 9:83. [PMID: 24886207 PMCID: PMC4045875 DOI: 10.1186/1749-8090-9-83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 04/24/2014] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE The aim of this prospective observational study was to evaluate the efficiency of a new escalating treatment strategy with vernakalant, flecainide and electrical cardioversion (EC) in patients with new onset atrial fibrillation (AF) after cardiac surgery. MATERIAL AND METHODS 24 patients with new onset AF after aortic valve surgery, coronary artery bypass surgery or combined procedures were evaluated in this study. Additional including criteria were age between 18 and 80, duration of AF less than four days, body weight less than 100 kg and no previous treatment with class I or III antiarrhythmic drugs. Exclusion criteria were poor left ventricular ejection fraction (LVEF < 40%) and history of myocardial infarction within 30 days. The patients were divided into converters and non-converters according to their response to combination treatment with vernakalant and flecainide, and the groups were compared. RESULTS The mean age of the population was 69.6 ± 6.3 years and 26.1% of patients were female. There were no statistically significant differences between the two groups in terms of height, weight, gender distribution, comorbidities, preoperative medication, left ventricular function and left atrium diameter. Interventricular septum (IVS) in the non-converted group was significantly thicker compared to the converted group: 14.0 ± 1.00 vs. 10.40 ± 2.59 mm (p = 0.036). While 14 patients (60.9%) were successfully converted into stable sinus rhythm by pharmacological treatment with vernakalant and flecainide, 9 patients (39.1%, non-converted group) remained in AF. However, seven of them could be converted after additional EC. CONCLUSION The combination of vernakalant and flecainide improves the conversion rate into a stable sinus rhythm in postcardiotomy patients with new onset AF compared to single drug therapy. Furthermore it might be an excellent precondition for successful EC in patients who are not converted after using both antiarrhtythmic drugs. Furthermore, left ventricular hypertrophy might be a potential negative predictor of successful pharmacological cardioversion.
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Affiliation(s)
- Mohamed Zeriouh
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Anton Sabashnikov
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Yeong-Hoon Choi
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Javid Fatullayev
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Hannes Reuter
- Department of Cardiology, Pneumology and Angiology, Heart Center of the University of Cologne, Cologne, Germany
| | - Aron-Frederik Popov
- Department of Thoracic and Cardiovascular Surgery, University Hospital of Goettingen, Goettingen, Germany
| | - Georg Langebartels
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Lucas Kimmig
- Department of Cardiology, Pneumology and Angiology, Heart Center of the University of Cologne, Cologne, Germany
| | - Parwis B Rahmanian
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Thorsten Wittwer
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Klaus Neef
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
| | - Jens Wippermann
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
| | - Thorsten Wahlers
- Department of Cardiothoracic Surgery, Heart Center of the University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne, University of Cologne, Cologne, Germany
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