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Bignami E, Andrei G. Pro: Mechanical Ventilation During Cardiopulmonary Bypass in Adult Cardiac Surgery. J Cardiothorac Vasc Anesth 2024; 38:1041-1044. [PMID: 38290867 DOI: 10.1053/j.jvca.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/27/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024]
Affiliation(s)
- Elena Bignami
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy.
| | - Giulia Andrei
- Anesthesiology, Critical Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Hartman YAW, Konijnenberg LSF, Dinnissen DJM, Rodwell L, Li WWL, Nijveldt R, van Royen N, Thijssen DHJ. Handgrip exercise in patients scheduled for cardiac surgery to attenuate troponin release: a feasibility study. Am J Physiol Heart Circ Physiol 2023; 325:H1144-H1150. [PMID: 37594488 DOI: 10.1152/ajpheart.00428.2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
Cardiac surgery, including surgical aortic valve repair (SAVR) and coronary artery bypass grafting (CABG), are associated with ischemia-reperfusion (I/R) injury. Single bouts of exercise, including handgrip exercise, may protect against I/R injury. This study explored 1) the feasibility of daily handgrip exercise in the week before SAVR and/or CABG and 2) its impact on cardiac I/R injury, measured as postoperative cardiac troponin-T (cTnT) release. Sixty-five patients undergoing elective SAVR and/or CABG were randomized to handgrip exercise + usual care (intervention, n = 33) or usual care alone (control, n = 32). Handgrip exercise consisted of daily 4 × 5-min handgrip exercise (30% maximal voluntary contraction) for 2-7 days before cardiac surgery. Feasibility was assessed using validated questionnaires. Postoperative cTnT release was assessed at 0, 6, 12, 18, and 24 h [primary outcome area under the curve (cTnTAUC)]. Most patients (93%) adhered to handgrip exercise and 77% was satisfied with this intervention. Handgrip exercise was associated with lower cTnTAUC (402,943 ± 225,206 vs. 473,300 ± 232,682 ng · min/L), which is suggestive of a medium effect size (Cohen's d 0.31), and lower cTnTpeak (313 [190-623] vs. 379 [254-699] ng/L) compared with controls. We found that preoperative handgrip exercise is safe and feasible for patients scheduled for SAVR and/or CABG and is associated with a medium effect size to reduce postoperative cardiac I/R injury. This warrants future studies to assess the potential clinical impact of exercise protocols before cardiac surgery.NEW & NOTEWORTHY Daily handgrip exercise in the week before elective cardiac surgery is safe and feasible. Handgrip exercise is associated with a medium effect size for less troponin-T release. Future larger-sized studies are warranted to explore the impact of (handgrip) exercise prior to cardiac surgery on clinical outcomes and direct patient benefits.
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Affiliation(s)
- Yvonne A W Hartman
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lara S F Konijnenberg
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniek J M Dinnissen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laura Rodwell
- Department of Epidemiology and Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wilson W L Li
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niels van Royen
- Department of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dick H J Thijssen
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
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Keijmel SP, Zwartkruis IMM, Jongenotter J, Geuzebroek GSC, Kouijzer IJE. Postoperative Inflammation and Fever After Elective Aortic Valve and Aortic Root Replacement: A Retrospective Cohort Study. Open Forum Infect Dis 2023; 10:ofad015. [PMID: 36726552 PMCID: PMC9887259 DOI: 10.1093/ofid/ofad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background Fever after cardiac surgery is common. More knowledge of postoperative fever could lead to better patient selection for diagnostic workup and empirical antibiotic treatment. We aimed to analyze the postoperative course of inflammation and fever after elective aortic valve and aortic root replacement. Methods In a retrospective single-center cohort study, we included 3 groups of patients after elective cardiac surgery: aortic root with aortic valve replacement (Bentall procedure, from 2014 to 2021), valve-sparing root replacement (VSRR, from 2014 to 2021), and isolated surgical aortic valve replacement (SAVR, from 2018 to 2021). Exclusion criteria were age <18 years, cardiac surgery other than described, use of deep-hypothermic circulatory arrest, reoperations, and preexisting infections. Primary outcome measure was the number of patients per group with postoperative fever (≥38°C). Secondary outcome measures were the percentage of patients per group with infections and outcome. Results Among 307 patients included (76 Bentall, 40 VSRR, 191 SAVR), 71% had postoperative fever. Fever occurred significantly more often in the Bentall (84%) and VSRR group (83%) compared with patients after SAVR (64%, P = .001). Seventeen patients had fever due to infection versus 202 with diagnoses of postoperative inflammation. In case of infection, fever was significantly higher (38.8°C vs 38.4°C, P = .03), and both the number of days with fever and hospital admission duration were significantly longer. Conclusions Postoperative fever is more often observed after Bentall procedure and VSRR compared to SAVR. In diagnoses of infection, there is a higher and prolonged fever.
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Affiliation(s)
- Stephan P Keijmel
- Correspondence: Stephan Keijmel, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands (); Ilse Kouijzer, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ()
| | - Iris M M Zwartkruis
- Department of Internal Medicine, Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jochem Jongenotter
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Guillaume S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ilse J E Kouijzer
- Correspondence: Stephan Keijmel, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands (); Ilse Kouijzer, MD, PhD, Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands ()
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Shahood H, Pakai A, Kiss R, Eva B, Szilagyi N, Sandor A, Verzar Z. Effectiveness of Preoperative Chest Physiotherapy in Patients Undergoing Elective Cardiac Surgery, a Systematic Review and Meta-Analysis. Medicina (Kaunas) 2022; 58:911. [PMID: 35888629 DOI: 10.3390/medicina58070911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022]
Abstract
Background and Objectives: Patients undergoing cardiac surgery are particularly vulnerable for developing postoperative pulmonary complications (PPCs). This systematic review and meta-analysis aimed to evaluate the role of preoperative chest physiotherapy in such patients. Materials and Methods: All original articles that assessed patients undergoing elective cardiac surgery, with preoperative chest physiotherapy, and compared them to patients undergoing elective cardiac surgery, without preoperative chest physiotherapy, were included. Animal studies, studies conducted prior to the year 2000, commentaries, or general discussion papers whose authors did not present original data were excluded. Studies assessing physiotherapy regimens other than chest physiotherapy were also excluded. The search was performed using the following electronic resources: the Cochrane Central Register of Controlled Trials, the PubMed central database, and Embase. The included studies were assessed for potential bias using the Cochrane Collaboration’s tool for assessing the risk of bias. Each article was read carefully, and any relevant data were extracted. The extracted data were registered, tabulated, and analyzed using Review Manager software. Results: A total of 10 articles investigating 1458 patients were included in the study. The studies were published from 2006 to 2019. The populations were patients scheduled for elective CABG/cardiac surgery, and they were classified into two groups: the interventional (I) group, involving 651 patients, and the control (C) group, involving 807 patients. The meta-analysis demonstrated no significant differences between the interventional and control groups in surgery time and ICU duration, but a significant difference was found in the time of mechanical ventilation and the length of hospital stay, favoring the interventional group. A significant difference was shown in the forced expiratory volume in 1s (FEV1% predicted), forced vital capacity (FVC% predicted), and maximum inspiratory pressure (Pi-max), favoring the interventional group. Conclusions: This study is limited by the fact that one of the included ten studies was not an RCT. Moreover, due to lack of the assessment of certain variables in some studies, the highest number of studies included in a meta-analysis was the hospital stay length (eight studies), and the other variables were analyzed in a fewer number of studies. The data obtained can be considered as initial results until more inclusive RCTs are conducted involving a larger meta-analysis. However, in the present study, the intervention was proved to be protective against the occurrence of PPCs. The current work concluded that preoperative chest physiotherapy can yield better outcomes in patients undergoing elective cardiac surgery.
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Shehata IM, Elhassan A, Jung JW, Urits I, Viswanath O, Kaye AD. Elective cardiac surgery during the COVID-19 pandemic: Proceed or postpone? Best Pract Res Clin Anaesthesiol 2020; 34:643-650. [PMID: 33004173 PMCID: PMC7368150 DOI: 10.1016/j.bpa.2020.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 01/01/2023]
Abstract
During this coronavirus disease 2019 (COVID-19) pandemic, there is an international call to postpone all elective surgeries. Cardiac surgery carries a combined risk for cardiac patients, who are at risk for higher complications of COVID-19, and healthcare workers. In response to the COVID-19 pandemic, the American College of Surgeons and the American Society of Anesthesiologists recommended a sustained reduction in the rate of new COVID-19 cases for 14 days before the resumption of the elective surgery, but postponing surgery may impact patients' daily activities and increase the risk the of deterioration of their cardiac condition. We will discuss the risks and benefits of the decision whether to postpone or proceed with elective cardiac surgical procedures during the escalating COVID-19 pandemic considering the specific risk of the cardiac patients, the unique characteristics of the surgery, and the international health system capacity.
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Affiliation(s)
| | - Amir Elhassan
- Desert Regional Medical Center, Cardiothoracic Anesthesia, Palm Springs, CA, USA
| | - Jai Won Jung
- Georgetown University School of Medicine, Washington, DC, USA
| | - Ivan Urits
- Beth Israel Deaconess Medical Center, Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA.
| | - Omar Viswanath
- Valley Pain Consultants – Envision Physician Services, Phoenix, AZ, USA,Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, USA,University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, USA,Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
| | - Alan D. Kaye
- Louisiana State University Health Shreveport, Department of Anesthesiology, Shreveport, LA, USA
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Borracci RA, Rubio M, Baldi J, Ingino CA, Barisani JL. Validation of age, creatinine and ejection fraction (ACEF) and Cockcroft-Gault ACEF scores in elective cardiac surgery. Medicina (B Aires) 2017; 77:297-303. [PMID: 28825573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023] Open
Abstract
The objective of this study was to evaluate the efficacy of age, creatinine and ejection fraction (ACEF) score and the modified ACEFCG model, incorporating creatinine clearance, to predict immediate operative mortality risk of patients undergoing elective cardiac surgery. A retrospective analysis was performed of prospectively collected data between 2012 and 2015, from a series of 1190 adult patients who underwent elective cardiac surgery. Operative risk mortality was assessed with ACEF, ACEFCG and EuroSCORE II. Overall mortality rate was 4.0% (48 cases), while mean mortality rates predicted by ACEF, ACEFCG, and EuroSCORE II were 2.3% (p = 0.014), 6.4% (p = 0.010) and 2.5% (p = 0.038), respectively. Overall observed/predicted mortality ratio was 1.8 for ACEF score, 0.6 for ACEFCG score and 1.6 for EuroSCORE II. The ACEF score demonstrated an adequate overall performance for the low- and intermediate-risk groups, but underestimated mortality for the high risk group. The ACEFCG score discriminatory power systematically improved the area under the ROC curve (AUC) obtained with the ACEF score; however, EuroSCORE II showed the best AUC. Overall accuracy was 56.1% for the ACEF score, 51.2% for the ACEFCG score and 75.9% for EuroSCORE II. For clinical use, the ACEF score seems to be adequate to predict mortality in low- and intermediate-risk patients. Though the ACEFCG score had a better discriminatory power and calibration, it tended to overestimate the expected risk. Since ideally, a simpler risk stratification score should be desirable for bedside clinical use, the ACEF model reasonably met the expected performance in our population.
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Affiliation(s)
- Raúl A Borracci
- Departamento de Cirugía Cardíaca, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. E-mail:
| | - Miguel Rubio
- Departamento de Cirugía Cardíaca, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Julio Baldi
- Departamento de Cirugía Cardíaca, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carlos A Ingino
- Departamento de Cirugía Cardíaca, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - José L Barisani
- Departamento de Cirugía Cardíaca, Hospital de Clínicas, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
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Silvay G, Zafirova Z. Ten Years Experiences With Preoperative Evaluation Clinic for Day Admission Cardiac and Major Vascular Surgical Patients: Model for "Perioperative Anesthesia and Surgical Home". Semin Cardiothorac Vasc Anesth 2015; 20:120-32. [PMID: 26620138 DOI: 10.1177/1089253215619236] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Admission on the day of surgery for elective cardiac and noncardiac surgery is the prevalent practice in North America and Canada. This approach realizes medical, psychological and logistical benefits, and its success is predicated on an effective outpatient preoperative evaluation. The establishment of a highly functional preoperative clinic with a comprehensive set up and efficient logistical pathways is invaluable. This notion in recent years has included the entire perioperative period, and the concept of a perioperative anesthesia/surgical home (PASH) is gaining popularity. The anesthesiologists as perioperative physicians can organize and lead the entire process from the preoperative evaluation, through the hosptial discharge. The functions of the PASH include preoperative optimization of medical conditions and psychological preparation of the patients and their support system; the care in the operating room and intensive care unit; pain management; respiratory therapy; cardiac rehabilitation; and specialized nutrition. Along with oversight of the medical issues, the preoperative visit is an opportune time for counseling, clarification of expectations and discussion of research, as well as for utilization of various informatics systems to consolidate the pertinent information and distribute it to relevant health care providers. We review the scientific foundation and practical applications of a preoperative visit and share our experience with the development of the preoperative evaluation clinic, designed specifically for cardiac and major vascular patients scheduled for day admission surgery. The ultimate goal of preoperative evaluation clinic is to ensure a safe, efficient, and cost-effective perioperative care for patients undergoing a complex type of surgery.
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Affiliation(s)
- George Silvay
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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