Candidates For Open-heart Surgery Research Articles

The effect of using virtual reality technology on anxiety and vital signs before surgery in patients undergoing open heart surgery

IntroductionPreoperative anxiety is one of the most common psychological problems in open-heart surgery patients. Not controlling this problem can negatively the operation outcome and the patient’s physical condition. Among various training methods and tools introduced to deal with this issue, the ideal method still remains unknown. Therefore, the present study was to determine the effect of using virtual reality technology on preoperative anxiety in patients undergoing open heart surgery.Materials and methodsThe participants of this interventional-educational study included 60 patients who were candidates for open heart surgery. The samples were randomly divided into two groups virtual reality(n = 30)and ordinary video (n = 30). For the virtual reality group, a virtual reality film and for the ordinary video group, an ordinary video of the physical space and operating room staff were displayed the day before the operation. Patients’ anxiety in both groups was assessed using the Spielberger State-Trait Anxiety Inventory (STAI) before and after the intervention. Data analysis was performed using the SPSS software version 25.ResultsThe mean anxiety score before the intervention was 55.8 and 58.33 in the virtual reality group and the ordinary video group, respectively. After the intervention, it reached 38.60 in the virtual reality group and 45.13 in the control group. There was no statistically significant difference between the anxiety scores of the subjects in the virtual reality and ordinary video groups before the intervention (p > 0.05). However, the difference between the anxiety scores of the subjects in the virtual reality and ordinary video groups after the intervention was significant (p < 0.05).ConclusionAlthough virtual reality and ordinary video interventions effectively reduce anxiety in heart surgery patients, virtual reality seems to lower anxiety in heart surgery patients by diverting attention from external stimuli and immersing the person in the virtual world more than ordinary video.

The outcome of sternum healing among diabetic patients undergoing open heart surgery: a literature review

Background: As part of the surgery, sternotomy is a common technique to expose the underlying organs, allowing surgeons to explore the targeted organ. Despite the benefits offered, it has several considerable complications; one of them is wound healing defect. The impairment of sternal wound healing after sternotomy could be superficial and/or deep. This condition is influenced by many factors, including diabetes mellitus, obesity, and other comorbidities. These anomalies will affect the normal healing process of the bone and other connective tissue, particularly after a major invasive event, such as in sternotomy. This study aimed to review the outcome of sternum healing among diabetics that underwent heart surgery with a sternotomy approach. Methods: Works of literature reviewed in this study were obtained from Pubmed and Google Scholar databases starting from 1992 until April 2022. The keywords used were ‘sternal wound healing’, ‘cardiac surgery’, and ‘diabetes mellitus’. An advanced search based on the exact phrases was conducted on Google Scholar. Gathered kinds of literature were then selected based on relevancy. Results: The majority of articles reviewed were observational, and most of them had CABG as a part of open heart surgery, followed by valvular and aortic surgeries and others. The incidence of impaired sternal healing and other complications (superficial and/or deep) was more commonly seen among patients with diabetes. Most studies also reported a significant correlation between DM and the incidence of impaired sternal healing, suggesting that DM was a significant predictor of it. Conclusion: Diabetes mellitus is a medical condition that must be taken into account among the candidates for open heart surgery, particularly if it is poorly controlled. The Hyperglycaemic state experienced by the patients will lead to multiorgan damage and immunological dysfunction that could affect the healing process of the sternum.

The Effect of Open Heart Surgery on FVC, FEV1 and FVC/FEV1 of Patients

Background: In Iran, 25000 open heart surgeries are performed annually, which are mainly dedicated to coronary artery bypass surgery. Pulmonary complications after open heart surgery impose a high socio-economic burden on the society because of the length of hospital stay and the use of mechanical means. In this study, we aimed to investigate the possibility of impaired forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FVC/FEV1 indices before and after open heart surgery, which has been directly addressed in fewer studies. Methods: In this cross-sectional study, all 125 candidates for open heart surgery who referred to Shahid Mohammadi Hospital of Bandar Abbas University of Medical Sciences during 2107-2018 were included. The patients were evaluated by spirometry three times. Before the operation, FEV1, FVC, FEV1/FVC were measured 3-10 days and 3-6 months after surgery. Then, the changes obtained from the evaluation were extracted three times before surgery, and 3-10 days and 3-6 months after surgery, using IBM SPSS, version 17, descriptive statistics (mean, standard deviation, percentage, etc.), and one-way and repeated measures analysis of variance. Results: FVC decreased by 0.6 in both patients with asthma and healthy ones. The mean FVC was also 0.4 in the diabetic group and 0.7 in the non-diabetic group. Mean FEV1 before surgery A, one week after surgery B and three to six months after surgery C in the two asthma and healthy groups showed a decrease of 1.2 and 1.3, respectively. Mean FEV1 before surgery A, one week after surgery B and three to six months after surgery C in smokers and non-smokers decreased by 0.9 and 1, respectively. Conclusion: Based on the results of our study, there is no doubt about the development of pulmonary dysfunction after heart surgery. This disorder occurred in the present study independent from asthma, diabetes, and smoking.

Investigating the Effect of Acupressure on the Patients’ Anxiety Before Open-Heart Surgery: A Randomized Clinical Trial

BackgroundAnxiety is a common complaint of patients before diagnostic or therapeutic invasive procedures, especially before open-heart surgery. The most well-known method to reduce anxiety is the use of sedatives, which have pronounced side effects. ObjectivesThe purpose of this study was to determine the effect of acupressure on anxiety in patients undergoing open-heart surgery. MethodThis is a randomized clinical trial study conducted on 90 patients who were candidates for open-heart surgery. The patients were randomly assigned into either intervention or control groups. Acupressure intervention was applied at three real acupoints over two consecutive days in the intervention group. The control group received acupressure on sham points. We used Spielberger State-Trait Anxiety Inventory to assess anxiety in our study. ResultsThe results showed that before acupressure, there was no statistically significant difference between state anxiety scores and intergroup traits, and this difference was only significant in state anxiety after the second intervention. State and trait anxiety were significant before and after the intervention in the test group, respectively include (p < 0.001) (p = 0.01), but these changes in the control group did not show a statistically significant difference. After completing the second phase of the intervention at the actual sites, systolic blood pressure (p = 0.007) and heart rate (p = 0.001) decreased significantly. However, acupressure did not have a significant effect on diastolic blood pressure in any of the groups. ConclusionBased on the results of this study, the application of acupressure in patients who are candidates for open-heart surgery can reduce their state anxiety. Further larger-scale and rigorous studies are warranted.

The influence of mean arterial blood pressure during cardiopulmonary bypass on post-operation acute kidney injury in hypertensive patients

Introduction: Over a period of time, kidney blood vessels will be damaged in those patients suffering from hypertension. Objectives: This study aimed to investigate the effect of mean arterial pressure during cardiopulmonary bypass (CBP). Patients and Methods: The present observational prospective study was conducted on 90 high risk patients, having records of hypertension and being candidates for open heart surgery. Patients divided into three groups based on their mean arterial pressure (MAP), lower than 60 mmHg (first group), between 60 to 70 mm Hg (second group) and higher than 70 mm Hg (third group) respectively during cardiopulmonary bypass. Clinical outcomes being studied included cardiac surgery-associated acute kidney injury (CSA-AKI) (RIFLE class), serum creatinine levels, glomerular filtration rate (GFR) and urinary output up to 24 hours after the surgery. Results: Data related to 90 case-patients have been analyzed. There was no difference between the groups in terms of demographic information. Prevalence of AKI in preliminary course after cardiac surgery was different among the groups. AKI occurred in six patients (15%) of the first group, five patients (12.5%) of the second group and two patients (5%) of the third group (P = 0.03). There have been no differences in terms of serum creatinine levels, GFR and urinary output during 24 hours after cardiac surgery, among the groups. However, delta creatinine level and delta GFR were significant in those groups with MAP of lower than 60 mm Hg and also between 60-70 mm Hg. Conclusion: This study showed that MAP level during CBP directly affects occurrence of AKI in patients after open heart surgery. High risk patients such as those suffering from hypertension have to be constantly monitored during CBP regarding their MAP. We concluded that MAP drops to lower than 70 mm Hg has to be prevented in hypertensive patients.

In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement in Relation to the Presence of Heart Failure in the United States: An Analysis of the National Inpatient Sample

Introduction Transcatheter aortic valve replacement (TAVR) is an increasingly common method of valve replacement in patients that are not candidates for open heart surgery. As TAVR is reserved for patients with intermediate risk, most patients who undergo TAVR are older. Although comorbid conditions are often present in these patients, there is a dearth of national studies evaluating outcomes in the presence of heart failure. We investigate whether the presence of heart failure impacts hospital utilization and mortality. Methods The 2016 National Inpatient Sample (NIS) was used to find all patients that underwent TAVR in 2016, comparing those with to those without heart failure (based on ICD-10-CM Codes). The codes for chronic systolic and diastolic heart failure were used, in addition to the code for combined systolic and diastolic heart failure to create a subgroup of heart failure patients. The codes for percutaneous endoscopic aortic valve replacement and other non-chronic forms of heart failure were excluded. STATA Version 15.1 (College Station, TX) was used for statistical analysis. Multivariate regression was used to calculate weighted nationwide estimates of hospital mortality, length of stay, and total charge. We adjusted for patient (age, sex, ethnicity, and Charlson Comorbidity Index), socioeconomic (median household income, insurance provider), and hospital factors (hospital bed size, region, teaching status, day and month of admission). Results A total of 40,005 patients who underwent TAVR in 2016 were identified. Of those, 12,080 had chronic heart failure. There was a significantly decreased length of stay (coefficient -1.97, p=0.000), total hospital cost (coefficient= -20685.16, p=0.000), and mortality (OR: 0.453, p=0.001) in patients with heart failure undergoing TAVR when compared to those without (Table 1). Conclusion Our study was the first to show decreased total hospital cost, length of stay, and in-hospital mortality among heart failure patients undergoing TAVR compared to those without heart failure. Further studies are required to elucidate the etiology of this difference.

In-Hospital Mortality in Patients Undergoing Transcatheter Aortic Valve Replacement in Relation to Heart Failure Status in the United States: An Analysis of the National Inpatient Sample

Introduction Transcatheter aortic valve replacement (TAVR) is an increasingly common method of valve replacement in patients that are not candidates for open heart surgery. Although comorbid conditions are often present in these patients, there is a dearth of national studies evaluating outcomes in the presence of heart failure. We investigate whether systolic and diastolic heart failure impact hospital utilization and mortality. Methods The 2016 National Inpatient Sample (NIS) was used to find all patients that underwent TAVR in 2016, comparing those with systolic versus diastolic heart failure (Based on ICD-10-CM Codes). Patients with non-chronic forms of heart failure and those who received percutaneous endoscopic aortic valve replacement were excluded. STATA Version 15.1 (College Station, TX) was used for statistical analysis. Multivariate regression was used to calculate weighted nationwide estimates of hospital mortality, length of stay, and total charge. We adjusted for patient (age, sex, ethnicity, and Charlson Comorbidity Index), socioeconomic (median household income, insurance provider), and hospital factors (hospital bed size, region, teaching status, day and month of admission). Results An estimated 40,005 pts who underwent TAVR in 2016 were identified. Of those, 2475 had systolic heart failure and 7830 had diastolic heart failure. After adjusting for confounders, patients with systolic heart failure had longer median length of stay (Table 1) compared to those with diastolic heart failure (+0.483 days, p=0.013). In contrast, no significant differences were found between in hospital mortality (OR 1.32, p=0.565) and total hospital charge (+5324 USD, p=0534). Conclusion Our study is the first to show that there is no significant difference in in-hospital mortality in systolic versus diastolic heart failure patients undergoing TAVR. There was also no difference in total hospital cost between systolic and diastolic heart failure, whereas systolic heart failure was associated with an increased length of stay.

Effect of Digital Storytelling on Anxiety in Patients Who Are Candidates for Open-Heart Surgery.

Open-heart surgery in persons with cardiovascular disease is associated with high levels of anxiety. The goal of this study was to determine the effect of digital storytelling on anxiety in patients who were candidates for open-heart surgery. In this quasi-experimental study, 80 patients were randomly allocated into 2 groups. The intervention group received routine training and digital storytelling. In each group, anxiety was measured by the State-Trait Anxiety Inventory anxiety scale before surgery and 5 days after surgery. The collected data were analyzed using SPSS software V18. There was no significant difference in the anxiety of both groups during the 2 days before the surgery (P = .40). After the surgery, the mean of anxiety scores in the intervention group was lower than that of the control group (P < .001). Digital storytelling is an effective method to reduce anxiety in patients who are candidates for open-heart surgery.

Anxiety and hope to life in open heart surgery patients-A cross sectional study

Background: Open heart surgery patients experience too much mental pressure, so this study has been made to investigate the relation between the anxiety and hope to life in open heart surgery patients. Methods: This study is a cross sectional study. Eighty patients, who have been the candidates for open-heart surgery in Fatemeh Zahra hospital in Sari-Iran, were selected through convenience sampling method. The data collection instruments included standard questionnaires to measure life hope, anxiety and life expectancy. The data were analyzed MANCOVA and Pierson. Results: Theresults showed that there was no significant statistical difference between anxiety scores and hope to life before open-heart surgery and a month after that (P>0.005). In addition, the correlation intensity between anxiety and hope to life was reversed, defective and significant (P=0.000 and r=-0.930). Conclusion: The finding of present study indicated that open-heart surgery patients have tolerated and experienced too much anxiety and also have low hope to life, therefore, they need more training and social and family support. Key words: Anxiety, Hope, Open heart surgery, Life expectancy, Stress.

Patents and Heart Valve Surgery – III: Percutaneous Heart Valves

Advancements in technology for the treatment of valvularcardiac diseases seek to provide solutions for high risk patients in the form of percutaneous valve insertion for patients with complicated valvular disease not amenable to more traditional options. Within the last decade, cardiac valves designed for percutaneous insertion have emerged rapidly as a treatment option for valvular disease. This procedure serves as an alternative to open heart surgery, which is more invasive and requires longer ICU stay. Thus, the percutaneous valve insertion procedure has been used on older, frailer patients who are poor candidates for open heart surgery. Designs for percutaneous valve insertion systems have been in development for decades, but have only recently been approved by the FDA for use. Important considerations include stent design, valve design, balloon catheter design, and deployment method.

Transcatheter aortic valve implantation in a patient with previous mitral valve replacement.

Transcatheter aortic valve implantation (TAVI) has shown favorable outcomes in patients with severe symptomatic aortic valve stenosis who are at high surgical risk or are unsuitable candidates for open heart surgery. However, concerns exist over treating patients who have previously undergone mitral valve surgery due to the potential interference between the mitral prosthetic valve or ring and the TAVI device. In this case report, we present a patient with symptomatic severe aortic stenosis and previous mechanical mitral valve replacement who was successfully treated with TAVI using a CoreValve.

The Next Revolution: Percutaneous Aortic Valve Replacement

Aortic valve replacement (AVR) is a treatment of choice for patients with symptomatic severe aortic stenosis (AS). However, a significant proportion of these patients do not undergo surgical AVR due to high-risk features. Transcatheter aortic valve implantation (TAVI) has emerged as an alternative for patients with severe AS who are not candidates for open-heart surgery. Since the introduction of TAVI to the medical community in 2002, there has been an explosive growth in procedures. The balloon-expandable Edwards SAPIEN valve and the self-expanding CoreValve ReValvingTM system contribute the largest patient experience with more than 10,000 patients treated with TAVI to date. Clinical outcomes have stabilized in experienced hands, with 30-day mortality less than 10%. Careful patient selection, growing operator experience, and an integrated multidisciplinary team approach contribute to notable improvement in outcomes. In the first randomized pivotal PARTNER trial, in patients with severe AS not suitable candidates for surgical AVR, TAVI compared with standard therapy, significantly improved survival and cardiac symptoms, but was associated with higher incidence of major strokes and major vascular events. The results of randomized comparison of TAVI with AVR among high-risk patients with AS for whom surgery is a viable option are eagerly awaited to provide further evidence on the applicability of TAVI in these patients.

Evaluation and Treatment of Carotid Stenosis in Open-Heart Surgery Patients

Indications for identification and treatment of extracranial carotid artery disease in candidates for open-heart surgery (OHS) remain unsettled. We evaluated the efficacy of OPG-GEE screening and our nonrandomized use of carotid endarterectomy in 2312 OHS patients from 1975 to 1989. Data was analyzed using the χ2 squared and Fisher's exact tests. OPG was performed in 1602/2312 (69%) of the patients. OPG was positive in 122/1602 patients (7.6%) and negative in 1480/1602 (92.4%) patients. Of the patients with positive OPG, 31 patients had insignificant carotid bifurcation disease, 32 patients had total internal carotid artery occlusion, and 59 patients had operable carotid bifurcation lesions. Selective use of angiography identified an additional 8 patients with operable carotid bifurcation lesions (total 67, 33 symptomatic and 34 asymptomatic). Overall stroke rate for 2312 patients was 40/2312 (1.7%) [30 day mortality rate 60/ 2312 (3.2%)]. Stroke incidence was significantly increased (P < 0.01) in patients with a positive OPG, 8/122 (6.60%) vs those with negative OPG (23/1480, 1.6%). However, it was most marked in patients with operable bifurcation lesions (6/67, 9.0%). Stroke was not increased in patients with carotid occlusion or positive OPG without significant carotid bifurcation disease (2/63, 3.20%). Carotid endarterectomy in patients with operable bifurcation lesions was associated with a decreased (P < 0.05) stroke rate after OHS (1/44, 2.30% vs 5/23, 21.7%). Our data suggests identification of significant carotid disease and carotid endarterectomy will decrease stroke after OHS.

Prediction of results in open heart surgery

One hundred candidates for open heart surgery were rated preoperatively by means of an Acceptance Scale. The rating was found to have a strong correlation with the result of surgery. It is believed that the scale is sufficiently predictive to allow identification of a high-risk group of patients who should receive an intensive ministry before they are operated on. The scale is probably applicable to a very broad variety of surgical patients.

Sizes of the great arteries in ventricular septal defect. Surgical significance of preoperative assessment by angiocardiography.

The sizes of the great arteries in patients with ventricular septal defect were studied and their correlations with hemodynamic data and surgical results were discussed. Intimate correlations could be found between pulmonary-to-systemic systolic pressure ratio and cross sectional area of the pulmonary artery or aorta-to-pulmonary artery diameter ratio. The ascending aorta was found absolutely hypoplastic in some cases with hyperkinetic pulmonary hypertension. In patients with increased pulmonary vascular resistance, the ascending aorta was not so hypoplastic as in hyperkinetic group. As patients with the hypoplastic aorta frequently showed fatal low cardiac output syndrome in the early postoperative period, such cases should be excluded from candidates for open heart surgery by preoperative angiocardiographic examination.

Thrombocytopathies in patients with open-heart surgery. Preoperative treatment with corticosteroids.

THE DEVELOPMENT of a hemorrhagic diathesis following an open-heart operation is a serious complication. 1 Hemorrhagic disease may develop as a function of: (1) abnormalities directly related to extracorporeal circulation such as thrombocytopenia, defibrination, or fibrinolysis, 2 (2) depressed coagulation factors associated with hepatic decompensation, (3) occult thrombocytopenia occurring in the setting of congestive splenomegaly or drug purpura, 3 and (4) subclinical qualitative defects of platelet function. Combinations of these abnormalities may also occur. In order to decrease the possibility of hemorrhagic complications following openheart procedures, a comprehensive coagulation study has been performed upon all adult patients at The New York Hospital-Cornell Medical Center who were candidates for open-heart surgery over the past 3½ years. Included in the comprehensive coagulation study have been the following determinations: clotting time (Lee-White), bleeding time (Duke), tourniquet test (Rumpel-Leede), clot retraction (Qualitative), platelet estimate (blood smear), platelet count (Phase), fibrinogen (Fowell), fibrinolysis (Euglobin), prothrombin

Blood loss in open heart surgery. Correlation with laboratory tests of hemostatic function.

SEVERAL studies of the prevention and treatment of excessive bleeding in extracorporeal circulation have been published.^1-17While inadequate surgical hemostasis^11,12,15and incomplete heparin neutralization^7,8,15-17are the most common causes of hemorrhage, changes in the platelets and plasma coagulation factors do occur, but they only occasionally contribute to blood loss.^{2-8,10-14,16,17} For the past five years, all candidates for open heart surgery at the Toronto General Hospital have routinely had preoperative studies of hemostatic function. During the past year similar tests have also been performed at the completion of perfusion. This review was undertaken in order to determine the cause of excessive blood loss and to assess the ability of the preoperative hemostatic tests to predict operative hemorrhage. While major bleeding is now an infrequent complication after cardiopulmonary bypass at this hospital, a recent survey¹⁸suggests that bleeding is still a major problem with some teams of