Open Heart Surgery Research Articles

Effect of Implementing Standardized Nursing Measures on Prevention of Pulmonary Atelectasis among Patients Undergoing Open Heart Surgeries

Effect of Implementing Standardized Nursing Measures on Prevention of Pulmonary Atelectasis among Patients Undergoing Open Heart Surgeries

Modified Ultrafiltration Technique in Valvular Heart Surgery: A Case Series

Abstract Application of cardiopulmonary bypass (CPB) in cardiac surgery may cause systemic inflammatory reactions, possibly causing clinical sequelae and multiple organ failures such as systolic or diastolic dysfunction, regional or global left ventricle or right ventricle low contractility, and the function of vascular tone. The use of drugs (i.e., corticosteroids) and the ultrafiltration method during the CPB application has been known to prevent or minimize the complication of CPB in cardiac surgery. One of the non-pharmacological approaches to minimize those inflammatory responses is the modified ultrafiltration (MUF) technique. Theoretically, this is due to ultrafiltration which may reduce the interstitial fluid and inflammatory mediator. MUF can be used to counteract inflammatory responses in pediatric cardiac surgery. This ultrafiltration method became a recommended procedure in minimally invasive surgery and conventional open-heart surgery. However, studies about effectiveness in adults are limited. In this case series, the MUF technique was used in three patients who underwent valvular heart surgery with a CPB machine. Following the application of the CPB, the MUF technique is performed for 10 min at a speed of no more than 10% full flow. Hemodynamic measurements and interleukin-6 (IL-6) levels were taken during surgery and 24 h post-CPB. At 24 h post-CPB, the vasoactive inotropic score and duration of mechanical support use were less than 20 and 18–24 h, respectively, and the IL-6 level ranged from 7.22 to 14.22 pg/mL. The cardiac index increased, ranging from 2.43 to 3.47 L/min/m2, and pulmonary vascular resistance decreased, ranging from 78 to 146 dyne s/cm5.

Effect of Cold Gel Pack Intervention on Controlling Pain Associated with Incentive Spirometry Post Open-Heart Surgery.

Effect of Cold Gel Pack Intervention on Controlling Pain Associated with Incentive Spirometry Post Open-Heart Surgery.

Mid-term outcomes of double-balloon technique for balloon aortic valvotomy: Experience from a tertiary care center in India

ABSTRACT We hypothesized that a double-balloon technique would be associated with a lower likelihood of aortic regurgitation (AR) following balloon aortic valvotomy (BAV). We present the short- and mid-term outcomes of the double-balloon technique for BAV. Fifty consecutive patients (median age: 6.5 years; interquartile range (IQR): 3.8–13.2) underwent BAV using double balloons. Prior AR was present in 17 (34%). Following BAV, the peak-to-peak gradient reduced from 80 (66.5–100) mm Hg to 24 (16–35) mm Hg (P < 0.0001); 10 (20%) had trivial AR, 18 (36%) had mild AR, 10 (20%) had moderate AR and none had severe AR. Four (8%) had transient arterial occlusion requiring anticoagulation. There was no procedure-related mortality or requirement for emergency open-heart surgery. The double-balloon technique offers a safe and effective alternative option for BAV in patients beyond infancy with relatively large annulus sizes. There is a low likelihood of postprocedural severe AR and the need for repeat procedures. Further long-term follow-up of this cohort is needed to ascertain long-term outcomes.

EARLY ACTIVATION PATHWAYS IN PATIENTS UNDERGOING OPEN HEART SURGERY WITH MULTICOMPONENT GENERAL ANESTHESIA COMBINED WITH HIGH THORACIC EPIDURAL ANESTHESIA

Background: Early mobilization of patients in the postoperative period after open heart surgeries, significantly decreases the risk of complications, accelerates the restoration of functional capacity, shortens the length of hospital stay, and reduces treatment costs Materials and methods: Open heart surgeries were performed on 60 patients at Ankara "Bayındır" Hospital, Central Clinical Hospital, and Baku Health Center were included in the study. Patients were divided into two groups. 30 of them underwent the procedure with the use of multi-component balanced general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization under high thoracic epidural anesthesia, with the administration of ropivacaine prior to induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Results: Thirty of them underwent the procedure with the use of multi-component general anesthesia and intravenous fentanyl analgesia in the postoperative period. The other group of 30 patients underwent catheterization of the high epidural space with the administration of ropivacaine before induction and, in the postoperative period, ropivacaine and fentanyl. We conducted a study on central hemodynamic parameters and analgesic effects. Conclusion: It has been established that for patients in the second group according to the Enhanced Recovery After Surgery strategy, hemodynamic support and effective pain management can contribute to early patient mobilization after surgery. Early mobilization, in turn, can expedite recovery and reduce the length of hospital stay, ultimately leading to potential cost savings.

A comparative analysis of open heart surgery and minimally invasive cardiac surgery in exercise-based cardiac rehabilitation

BackgroundHistorically, the majority of patients admitted to inpatient exercise-based cardiac rehabilitation (EBCR) have undergone open heart surgery (OHS). However, with advances in minimally invasive cardiac surgery (MICS), these patient groups are also increasingly referred for inpatient EBCR. Herein, we aimed to compare the progress of these groups during rehabilitation.MethodsIn this prospective, nonrandomized study, 403 inpatient EBCR patients were recruited from December 2022 until September 2023 and stratified into two groups: OHS, and MICS. Participants completed a 3-4-week certified EBCR program. The primary endpoint was defined as a change in the 6-minute walk test (6MWT). Moreover, a comprehensive panel of quality-of-life (QoL) assessments were performed at admission and discharge.ResultsAt baseline, patients with OHS were older (66 years [IQR 59 – 72]), more often male (83%), and underwent emergency/urgent procedures more often (20%) than patients with MICS. Furthermore, patients with MICS showed a better 6MWT at admission (426 meters [IQR 336 – 483]) compared to patients with OHS (381 meters [IQR 299 – 453]). While all patients were able to increase the distance in the 6MWT, regression analyses in fully adjusted models showed no difference in improvements between the two groups (β -5, 95% CI, -26 – 14, p = 0.58). Moreover, during EBCR, we observed significant improvements in all QoL measures in all groups.ConclusionsIn this study, improvements in fitness, as assessed by the 6WMT were observed in all groups. Furthermore, multiple QoL measures improved equally across all groups. These encouraging results emphasize the importance of EBCR.

Quality of life of patients one month after open heart surgery according to the sf-36 health scale

ABSTRACT Introduction: Quality of life after open heart surgery shows the level of impact on the patients; moreover, it also reflects physical, functional, and psychosocial decline caused by diseases of the entity. This study evaluates the characteristics of quality of life of patients one month after open heart surgery according to the SF-36 health scale at Hue Central Hospital. Methods: This was a cross - sectional descriptive study of 217 patients who underwent open heart surgery at the Cardiovascular Center, Hue Central Hospital, from August 1, 2022, to April 30, 2023. Results: The mean general quality of life score was 64.21 ± 15.71, and the mean physical and mental component summary scores were 69.44 ± 16.08 and 58.98 ± 15.74, respectively. The average of eight health domains scores was physical functioning (84.42 ± 12.21); role physical (86.17 ± 22.41); bodily pain (46.77 ± 20.47); general health (60.38 ± 14.17); vitality (62.05 ± 27.01); role emotional (58.54 ± 11.27); mental health (64.22 ± 12.74); social functioning (51.09 ± 14.51). The mean anxiety disorder and perceived level of social support scores were 9.28 and 65.14, respectively. Conclusion: The quality of life of patients after open heart surgery is quite good, anxiety disorders and perceived levels of social support are high.

Incidence, Risk Factors and Outcomes of Acute Kidney Injury in Neonates Undergoing Open-heart Surgeries: Single Center Experience.

Incidence and outcomes of acute kidney injury (AKI) among neonates who underwent open-heart surgery are not well highlighted in the literature. We aim to assess the incidence, risk factors, and outcome of AKI among neonates undergoing open-heart surgery. This is a retrospective cohort study between 2016 and 2021 for all neonates requiring open heart surgery. The cases were divided into 2 groups: the AKI (index) group and the non-AKI (control) group. The two groups were statistically compared for risk factors, needs for dialysis, and outcomes. 100 patients fulfilled the inclusion criteria. Among them, 74 (74%) developed AKI, including 41 (55%), 15 (21%), and 18 (24%) patients in KDIGO stages 1, 2, and 3, respectively. Multivariate analysis comparing both groups demonstrated that low pre-operative creatinine (p = 0.01), prolonged bypass time (p = 0.0004) and high vasoactive inotropic score (VIS), (p = 0.0008) were risk factors for developing AKI post-operatively. Furthermore, in the AKI group, 17 (23%) neonates required renal replacement therapy in the form of peritoneal dialysis. The length of stay was higher in the AKI index group (p = 0.015). Patients who had AKI recovered their kidney function at discharge. There was no difference in mortality between both groups. The AKI occurred in 74% of neonates undergoing open-heart surgery, with 23% of them needing peritoneal dialysis. Low pre-operative creatinine, high VIS score, and prolonged bypass time are potential risk factors for AKI development after neonatal open-heart surgery. AKI may lead to prolonged hospitalization, though most affected patients recovered their normal kidney function at discharge.

Peri-operative fever and LVAD: SIRS or impaired right ventricular strain?

An inflammatory milieu after left ventricular assist device (LVAD) implantation is associated with multi-organ dysfunction and pre-operative heightened inflammatory state is associated with right ventricular failure after LVAD implantation. We performed a retrospective analysis of 30 LVAD patients in our institution within the last 2 years for the development of fever and compared them to 30 non-LVAD open-heart surgery patients. Our results suggest that patients undergoing LVAD implantation are more likely to develop fever in the immediate post-operative period compared to other open-heart surgeries. This is independent of pharmacological treatment, age, or ethnical background. Females and obese patients were more likely to develop fever. Patients with right ventricular dysfunction, as demonstrated by elevated central venous pressure (CVP), had the strongest correlation with fever development. These results pose the question if there is a systemic inflammatory response-like phenomenon driven by increased right ventricular dysfunction.

Post-operative delirium following open heart surgery: a commentary.

Post-operative delirium following open heart surgery: a commentary.

Diagnostic and Management Value of Multi-Slice Computed Tomography in Esophageal Jujube Pit Impaction

Objective: The diagnostic value of multi-slice computed tomography (MSCT) in esophageal jujube pit impaction was explored in this study. Methods: A retrospective analysis was performed on MSCT data obtained from a cohort of 40 patients experiencing esophageal jujube pit impaction. The study period encompassed the interval from December 2018 to November 2019. The analysis involved examining the age distribution of the patients, the location of the jujube pit impaction, its connection to the esophagus, associated complications, and the methods used for treatment. All imaging results were compared with the outcomes of surgical or endoscopic interventions. Results: (1) Out of 40 patients, 30 individuals were 58 years old or above, constituting 75% of the study sample. (2) In 80% of the instances (32 cases), the jujube pit was located in the initial segment of the esophagus, exhibiting a spindle shape with varying levels of central low density. (3) We examined the correlation between the angle of the impacted jujube pit and the esophageal longitudinal axis, categorizing 2 cases as longitudinal impaction, 16 as oblique impaction, and 22 as transverse impaction. Among the 40 cases, 28 displayed only slight thickening of the esophageal wall at the impaction site, while 9 cases exhibited heightened periesophageal fat density, and 3 showed small periesophageal air bubbles. (4) Endoscopic evaluation identified damage to the esophageal mucosa in 35 instances and the formation of esophageal perforation in 5 cases. Among patients with perforation, one or both ends of the jujube pit had penetrated the esophageal wall, accompanied by different levels of surrounding inflammatory encapsulation. Conclusion: MSCT is crucial for pinpointing jujube pit impaction and its relation to the esophageal wall and nearby structures, aiding in preoperative and postoperative complications. It is highly feasible for endoscopic cases but limited in complex ones needing thoracoscopy or open-heart surgery.

The Effect of Ketamine Administration on the Incidence of Delirium After Coronary Artery Bypass Graft Surgery: A Scoping Review

Context: Delirium is a common complication observed in patients undergoing open-heart surgery, leading to adverse outcomes and increased healthcare costs. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist with analgesic and neuroprotective properties, has been reported to have potential protective effects against delirium. In this scoping review, we aim to explore the existing literature on the effect of ketamine administration in open-heart surgery on the incidence of delirium. Evidence Acquisition: In the latter part of 2023, a retrospective analysis was conducted to investigate the impact of administering ketamine on delirium occurrence following coronary artery bypass surgery. Researchers utilized Medical Subject Headings (MeSH) to identify key terms and searched various databases, including Scopus, Web of Science, PubMed, and Cochrane, as well as search engines like Google Scholar, alongside Iran SID and Iran ISC databases. Following the elimination of duplicates and irrelevant studies, the review encompassed six studies from Iran, Turkey, Canada, the United States, and Thailand. Results: The search strategy yielded 1100 articles, of which 100 were excluded due to duplicates. After excluding conference papers, systematic reviews, unrelated languages, unavailable full texts, and book chapters, 87 full-text studies were reviewed. Finally, 6 studies (5 studies in English and one study in Persian) met the inclusion criteria and were analyzed. Conclusions: Recent trials have shown that the effect of ketamine administration on the incidence of delirium after coronary artery bypass graft (CABG) surgery is equivocal. While some studies suggest that ketamine may serve as a promising solution for reducing the incidence of delirium, others suggest that it may lead to adverse experiences and raise concerns about its safety. Further research in this area is necessary to optimize postoperative recovery and minimize risks. Currently, physicians must carefully evaluate the potential benefits and side effects of ketamine for each patient and be aware of the latest evidence.

Ultrasound-guided mid-point transverse process to pleura block versus thoracic paravertebral block in pediatric open-heart surgery: A randomized controlled non-inferiority study

Study objectiveThe mid-point transverse process to pleura block (MTPB) is a new variant of thoracic paravertebral block (TPVB). This study aimed to compare TPVB and MTPB with respect to intraoperative attenuation of the hemodynamic stress response to surgery and postoperative analgesia in pediatric open heart surgery with midline sternotomy. DesignA single-center, randomized, controlled, double-blind, non-inferiority study. SettingTertiary care children's university hospital. PatientsWe recruited 83 children aged 2–12 years of both sexes with American Society of Anesthesiologists (ASA) physical status class II who were scheduled for elective open cardiac surgeries with midline sternotomy for the repair of simple noncyanotic congenital heart defects. InterventionsEligible participants were randomized into either the TPVB or MTPB groups at a ratio of 1:1. In the TPVB group, patients were bilaterally injected with 0.4 ml/kg of 0.25% bupivacaine in the paravertebral space at T4 and T5. In the MTPB group, patients were bilaterally injected with 0.4 ml/kg of 0.25% bupivacaine mid-transverse process and pleura just posterior to superior costotransverse ligament at the level of T4 and T5. MeasurementsThe primary outcome was the hemodynamic responses to sternotomy incision, including heart rate (HR) and invasive mean arterial pressure (MAP), recorded before and after the induction of anesthesia, after skin incision, after sternotomy, 15 min after cardiopulmonary bypass (CPB), and after the closure of the sternum. The secondary outcomes were time needed to perform the bilateral block, intraoperative fentanyl consumption, postoperative fentanyl consumption, modified objective pain score (MOPS) measured at 1, 2, 6, 12, 18, and 24 h after extubation, extubation time, intensive care unit (ICU) discharge time, and the incidence of non-surgical complications (postoperative pruritus, postoperative vomiting, pneumothorax, hematoma or local anesthetic toxicity). Main resultsThere were no significant differences in HR and MAP in the TPVB group compared with the MTPB group at the following time points: baseline, after induction, after skin incision, after sternotomy, 15 min after CPB, and after sternal closure. Intergroup comparisons of HR and MAP did not reveal significant differences between the groups. The median (IQR) time needed to perform bilateral MTPB (7[6–8] min) was significantly (p < 0.001) shorter than that of TPVB (12[10−13] min). Intraoperative fentanyl consumption and fentanyl consumption in the first postoperative 24 h after extubation were similar in the TPVB and MTPB groups (4[2–4] vs 4[2–4] and 4.66 ± 0.649 vs 4.88 ± 1.082 μg/kg), respectively. Extubation time and ICU discharge time were comparable in the TPVB and MTPB groups (2[1–3] vs 2[1–3] h and 21.2 ± 2.5 vs 20.8 ± 2.6 h), respectively. Measurements of MOPS pain scores at 1, 2, 6, 12, 18, and 24 h after extubation were similar in both groups. The incidence of nonsurgical complications was similar in both groups. ConclusionsMTPB is non-inferior to TPVB in attenuating the intraoperative hemodynamic stress response to noxious surgical stimuli and in reducing perioperative opioid consumption, extubation time, and ICU discharge time. Moreover, MTPB is technically easier than TPVB and requires less time to perform.Clinical trial registration numberThe clinical trial registration was prospectively performed at the Pan African Clinical Trials Registry (PACTR202204901612169, approval date 01/04/2022, URL https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22602).

Left atrial volume index and interleukin-6 as predictors for postoperative atrial fibrillation

BackgroundPostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. However, the predictive value of single indictor still remains controversial. This study aimed to assess the predictive value of combining preoperative left atrial volume index (LAVI) and postoperative interleukin-6 (IL-6) for POAF in the patients receiving cardiac surgery.MethodsPatients who admitted to Nanjing First Hospital during the study period between December 2022 and June 2023, and underwent open-heart surgery without a history of atrial fibrillation (AF) were enrolled. The relationships between predictors and POAF were investigated using logistic regression analysis. We determined the combined predictive value of LAVI and IL-6 for POAF by measuring the changes in the area under the receiver operating characteristic curve (AUC) and calculating the net reclassification improvements (NRIs) and integrated discrimination improvement (IDIs).Results102 patients were enrolled in this study, and 50 participants developed POAF (49.0%). Patients who experienced POAF had higher levels of preoperative LAVI and postoperative IL-6 than those who did not. Regression analysis revealed that larger LAVI and higher level of IL-6 were independently associated with increased risk of POAF. The combined addition of LAVI and IL-6 to the predictive model resulted in an evident increase in the AUC. Incorporating both LAVI and IL-6 increased IDIs in all models.ConclusionOur results demonstrated that combined LAVI and IL-6 achieved a higher prediction performance for POAF.

The Medipol Combination: Novel Rectointercostal Fascial Plane Block and Pectointercostal Fascial Plane Block for Postoperative Analgesia Management After Cardiac Surgery: A Report of 15 Cases.

The parasternal blocks cannot cover the T7 and lower anterior and lateral branches of the thoracoabdominal nerves. In the open heart surgeries, chest drainage tubes are generally outside the target of the parasternal blocks. Recently, Tulgar et al described a novel interfascial plane block technique named "recto-intercostal fascial plane block" (RIFPB). RIFPB is performed between the rectus abdominis muscle and the sixth to seventh costal cartilages. RIFPB targets the anterior and lateral cutaneous branches of the T6-T9 thoracoabdominal nerves. In this clinical report, we want to share our experiences about pectointercostal plane block and RIFPB combination (Medipol Combination) after cardiac surgery.

Anesthetic Management Recommendations Using a Machine Learning Algorithm to Reduce the Risk of Acute Kidney Injury After Cardiac Surgeries.

Open heart surgeries are a common surgical approach among patients with heart disease. Acute kidney injury (AKI) is one of the most common postoperative complications following cardiac surgeries, with an average incidence of 6 - 10%. Additionally, AKI has a mortality rate of 5 - 10%. One of the challenges of cardiac surgeries is selecting the appropriate anesthetic approaches to reduce the risk of AKI. This study presents a machine learning-based method that consists of two regression models. These models can inform the anesthesiologist about the risk of AKI resulting from the improper selection of anesthetic parameters. In this cohort study, the medical records of 998 patients who underwent cardiac surgery were collected. The proposed method includes two regression models. The first regression model recommends optimal anesthesia parameters to minimize the risk of AKI. The second model provides the anesthesiologist with the safest margin for deciding on anesthetic parameters during surgery, including cardiopulmonary bypass (CPB) time, anesthesia time, crystalloid dose, diuretic dose, and transfusion of packed red cells (PC) and fresh frozen plasma (FFP). Using this method, the specialist can evaluate the anesthetic parameters and assess the potential AKI risk. Additionally, the proposed method can also provide the treatment team with anesthetic parameters that carry the lowest risk of AKI. This method was evaluated using data from 526 patients who suffered from postoperative AKI (AKI+) and 472 who did not suffer any injury (AKI-). The accuracy of the proposed method is 80.6%. Additionally, the evaluation of the proposed method by three experienced cardiac anesthesiologists shows a high correlation between the results of the proposed method and the opinions of the anesthesiologists. The results indicated that the outputs of the proposed models and the designed software could help reduce the risk of postoperative AKI.

Effects of antibiotics, hospitalisation and surgical complications on self-reported immunological vulnerability following paediatric open-heart surgery and thymectomy: a single-centre retrospective cohort study

BackgroundPartial or complete thymectomy is routinely performed in paediatric open-heart surgeries when treating congenital heart defects. Whether or not thymectomised children require systematic immunological monitoring later in life is unknown....

Effective Oral Indicators With Medical and Dental Collaboration in Open Heart Surgery: A Representative Survey.

Purpose Postoperative infections pose an important problem for patients with cardiac disease. Moreover, oral health status is associated with the risk of longer hospital stays. Therefore, the oral health status of patients was assessed before open-heart surgery. This study aimed to determine the relationship between oral health status and postoperative status. Methods The study included 25 patients who underwent open-heart surgery at our university hospital in 2020. Upon admission, dentists conducted an oral examination and assessed the oral health status of the patients, also using the Japanese version of the Oral Health Assessment Tool (OHAT-J), Revised Oral Assessment Guide (ROAG), oral moisture level, oral bacteria, and other relevant factors. The study investigated the association with postoperative status. Findings Significant postoperative infections were found in patients aged ≥70 years, with an OHAT-J score of ≥5, OHAT-J lip score of ≥1, Streptococcus γ count of 1.0 × 10^6 or higher (CFU/mL), and increased Streptococcus γ before and after surgery. The duration of hospitalization correlated with the OHAT-J, OHAT-J gum and tissue, and ROAG scores. The duration of intensive care unit (ICU) stays correlated with the OHAT-J score. Conclusions The study demonstrates that OHAT-J scores are linked with predicting not just postoperative infection but also the length of hospitalization and ICU stay. As OHAT-J scores do not necessitate specialized dental instruments, they are straightforward and beneficial for healthcare professionals outside of dentistry.

Subclinical leaflet thrombosis and anticoagulation strategy following trans-catheter aortic valve replacement: A systematic review.

Subclinical leaflet thrombosis (SLT) develops in 15% of patients undergoing trans-catheter aortic valve replacement (TAVR). TAVR is a procedure in which a faulty aortic valve is replaced with a mechanical one. An aortic valve replacement can be done with open-heart surgery; this is called surgical aortic valve replacement (SAVR). A significant problem is defining the best course of treatment for asymptomatic individuals with SLT post-TAVR, including the use of oral anticoagulation (OAC) in it. Systematic review. The most pertinent published research (original papers and reviews) in the scientific literature were searched for and critically assessed using the online, internationally indexed databases PubMed, Medline, and Cochrane Reviews. Keywords like "Transcatheter valve replacement" and "Subclinical leaflet thrombosis" were used to search the papers. Selected studies were critically assessed for inclusion based on predefined criteria. The review examined the prevalence and characteristics of SLT after TAVR. To note, the incidence of SLT is seen to be higher in TAVR compared SAVR. Dual antiplatelet therapy, which is utilized in antithrombotic regimens post-TAVR, can possibly hasten SLT progression which could result in the impaired mobility of leaflets and the worsening of pressure gradients. The use of dual antiplatelet drugs in routine antithrombotic therapy tends to accelerate initial subclinical leaflet thrombosis after TAVI, which results in a developing restriction of leaflet mobility and an increase in pressure differences.

The benefit of early phase 2 cardiac rehabilitation on exercise capacity in worsening anxiety and depression patients after open-heart surgery

The benefit of early phase 2 cardiac rehabilitation on exercise capacity in worsening anxiety and depression patients after open-heart surgery