Outcome Of Open Heart Surgery Research Articles

EFFECT OF PERIOPERATIVE DEXMEDETOMIDINE ON CARDIAC SURGERY OUTCOME

This retrospective study was designed to assess the impact of perioperative dexmedetomidine on the outcome of open-heart surgery. This study was conducted at the Faisalabad Institute of Cardiology Faisalabad from 01 Jan 2022 to Dec 2022. A total of 350 fulfilled the inclusion criteria and were included in the study. Informed consent of the participants was taken. The ethical board of the hospital approved the study. Subjects were divided into the dexmedetomidine group (who were administered dexmedetomidine peri operatively, 179 (51%)) and non-dexmedetomidine group (who were not helped dexmedetomidine peri operatively, 171(48.8%).0.24-0.6 μg/kg/h was infused intravenously after cardiopulmonary bypass. The was continued for more than twenty-four hours postoperatively.10 out of 350 subjects (2.8%) died in hospital, and 14 (4%) died within thirty days. Perioperative dexmedetomidine infusion resulted in a significant reduction in hospital and 30-day mortality. In-hospital mortality in the dexmedetomidine and non-dexmedetomidine group were 1.22% and 4.6%, respectively (P=.008). 30-day mortality in the dexmedetomidine and non-dexmedetomidine groups was 1.8% and 5.2%, respectively (P=.002). Perioperative dexmedetomidine significantly reduced post-operative sepsis (0.8% vs. 2.2%, P=.043) and other complications (46.19% vs. 56.07%, P=.0205). There was no difference in the duration of hospital stay, ICU stay, post-operative ventilation time, and incidence of delirium and MACEs. So, it can be concluded that perioperative intravenous dexmedetomidine results in improved hospital and thirty-day survival and is associated with a decrease in post-operative delirium and overall complications.

Outcome of open heart surgery in patients with age above 75 years.

Objectives: Open heart surgery is considered as high risk procedure in elderly patients. We study the operative outcomes of open heart surgery in patients of age above 75 years in geography of world where life expectancy is around 67 years. Study Design: Retrospective Study. Setting: Research of Rawalpindi Institute of Cardiology (RIC). Periods: From January 2014 to December 2018. Material & Methods: Demographic and baseline characteristics of patients were retrieved from cardiac surgery database (cascade, Lahore) of RIC. For all patients who underwent open heart surgery and had age above 75 years. Operative mortality, neurological outcome, low cardiac output state(LCOS), peri-operative myocardial infarction, postop.erative atrial fibrillation (POAF), acute kidney injury (AKI), chest reopening, ICU stay, hospital stay and 1-year survival etc. Are analyzed from retrieved data. Results: Operative mortality is 5.71%, type II neurological deficit is 16.42% and POAF is 25%. Incidence of peri-operative mi, lcos, aki and chest reopening etc is low along with acceptable ICU stay and hospital stay durations. 1-years survival is 95.46%. Conclusion: open heart surgery can be offered to patients with age above 75 years with low operative mortality and morbidity except with relatively higher incidence of type ii neurological deficit and POAF. 1- years survival is impressive with figures of 95.46%.

Árangur kransæðahjáveituaðgerða og ósæðarlokuskipta hjá öldruðum

To study the outcome of open heart surgery in an increasing population of elderly patients in Iceland. A retrospective study of patients (n=876) that underwent coronary artery bypass (CABG) or aortic valve replacement (AVR) for aortic stenosis in Iceland 2002-2006. Complication rates, operative mortality and long-term survival were compared between patients older (n=221, 25%) and younger (n=655, 75%) than 75 years. Long-term survival of the older group was compared to an age and sex matched reference population. Older patients had a higher incidence of atrial fibrillation (57% vs. 37%, p<0.001), stroke (5% vs. 1%, p=0.009) and operative mortality (9% vs. 2%, p<0.001) following CABG. Length of ICU stay was similar but total length of stay was one day longer in the older cohort. Following AVR, older patients had a higher incidence of atrial fibrillation (90% vs. 71%, p=0.006), ARDS (19% vs. 7%, p=0.04), myocardial infarction (21% vs. 8%, p=0.05) and operative mortality (11% vs. 2%, p=0.04). The ICU stay was a day longer and the total length of stay was about four days longer in the older cohort. A total of 75% of the older patients were alive five years after CABG, compared to 74% of the reference population (p=0.87). Similar numbers for AVR were 65% for the patients compared to 74% in the reference population (p=0.06). The rate of complications, operative mortality and length of hospital stay is higher in patients older than 75 years compared to younger patients. Survival of the older group of patients indicates good long-term results after open heart surgery for this patient cohort.

Outcomes of open heart surgery in patients with end-stage renal disease.

BackgroundCardiovascular diseases of chronic dialysis patients are often undertreated because of their higher surgical risk. This study aimed to assess mortality and morbidity after open heart surgery in chronic dialysis patients compared to those with normal renal function and identify risk factors for postoperative outcomes.MethodsWe retrospectively analyzed 2,432 patients who underwent open heart surgery from 2002 to 2017 and collected data from 116 patients (38 patients on dialysis and 78 age-, sex-, and diabetes mellitus status-matched control patients with normal kidney function). We assessed comorbidities, New York Heart Association (NYHA) class, laboratory data, surgical methods, and postoperative outcomes.ResultsThe dialysis group had more comorbidities, higher NYHA classes, and greater need for urgent surgeries compared to the control group. They exhibited significantly higher postoperative mortality (18.4% vs. 2.6%, P = 0.005) and more overall complications (65.8% vs. 25.6%, P < 0.001). Dialysis itself significantly increased relative risk for in-hospital mortality after adjustment. EuroSCORE II was not as useful as in the general population. Multivariate logistic regression analysis demonstrated that total (adjusted odds ratio [AOR], 10.7; P = 0.029) and in-hospital death risk (AOR, 14.7; P = 0.033), the durations of postoperative hospitalization (AOR, 4.6; P = 0.034), CRRT (AOR 36.8; P = 0.004), and ventilator use (AOR, 7.6; P = 0.022) were significantly increased in the dialysis group.ConclusionThe dialysis group exhibited a higher risk for mortality and overcall complications after open heart surgery compared to the patients with normal renal function. Therefore, the benefit of surgical treatment must be balanced against potential risks.

Influence of High-Risk for OSA on Outcomes of Open Heart Surgery: A Retrospective Analysis

SESSION TITLE: Cardiothoracic SurgerySESSION TYPE: Original Investigation PosterPRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PMPURPOSE: There has been an increasing incidence of Obstructive Sleep Apnea (OSA) with increasing obesity. Previous studies shown that OSA increases health c

Long-Term Quality of Life after Cardiac and Thoracic Aortic Surgery for Very Elderly Patients 85 Years or Older.

We evaluated the outcomes of open heart surgery and long-term quality of life for patients 85 years and older. We enrolled 46 patients 85 years and older who underwent cardiac and thoracic aortic surgery between May 1999 and November 2012. Long-term assessment was performed for 43 patients; three patients who died in the hospital were excluded. Patient conditions were assessed before surgery, 6 months and 12 months after surgery, and during the late period regarding the need for nursing care, degree of independent living, and living willingness. Three patients (6.5%) died during hospitalization and 22 (51%) died during the follow-up period. The 1-, 3-, 5-year survival rates were 74%, 49%, and 36%. During the late period, of 21 surviving patients, 18 patients (85%) were living at home. The need for nursing care was comparable before and after surgery. The degree of independent living decreased after surgery. Living willingness was similar before and after surgery. Among patients 85 years or older who underwent open heart surgery, 85% were living at home. All patients could perform activities of daily living without any assistance while maintaining living willingness.

Carbon dioxide insufflation and neurocognitive outcome of open heart surgery.

Neurocognitive dysfunction continues to be the bane of open heart surgery despite vast improvements in surgical, anesthetic, and postoperative management. This observational cohort study was carried out to evaluate the efficacy of intraoperative CO2 insufflation by the field flooding technique in reducing postoperative neurocognitive dysfunction. Three hundred randomly selected patients undergoing open heart surgery were observed: 150 (group A) were exposed to CO2 insufflation, and the other 150 (group B) were not exposed to CO2. Anesthetic, cardiopulmonary bypass, and myocardial protection techniques were standardized and similar in both groups. Neurocognitive function tests were performed preoperatively, 1 week postoperatively, and after 1 month. The analysis revealed that neurocognitive dysfunction occurred in 8 of 150 patients in group A (incidence p1 = 0.053) and 27 of 150 in group B (incidence p2 = 0.18). The relative risk of neurocognitive dysfunction was 0.30 (p = 0.001, 95% confidence interval 0.14-0.63), implying that CO2 insufflation is protective against neurocognitive dysfunction. The risk difference was 0.13 (p2-p1); this implies that 13% of patients can be prevented from developing neurocognitive dysfunction if exposed to CO2. This study confirms the known advantage of the relatively underutilized practice of CO2 insufflation. We recommend that CO2 insufflation be performed in all open heart surgery cases to bring down the incidence of neurocognitive dysfunction. This technique is simple to use without any major paraphernalia or additional cost.

Comparison of Outcomes of Patients With Left Ventricular Ejection Fractions ≤30% Versus ≥30% Having Transcatheter Aortic Valve Implantation (from the German Transcatheter Aortic Valve Interventions Registry)

Transcatheter aortic valve implantation (TAVI) is rapidly evolving in Germany. Especially severe reduced left ventricular ejection fraction (LVEF) is known as a prominent risk factor for adverse outcome in open heart surgery. Thus, the data of the prospective multicenter German Transcatheter Aortic Valve Interventions Registry were analyzed for outcomes in patients with severe depressed LVEF. Data of 1,432 patients were consecutively collected after transcatheter aortic valve implantation. Patients were divided into 2 groups (A: LVEF ≤30%, n= 169, age 79.9 ± 6.7years, logES 34.2 ± 17.8%; B: LVEF >30%, n= 1,263, age 82.0 ± 6.1years, logES 18.9 ± 12.0%), and procedural success rates, New York Heart Association classification, and quality of life were compared at 30days and 1 year, respectively. Technical success was achieved in 95.9% (A) and 97.6% (B). Survival and the New York Heart Association classification at 30days demonstrated an excellent outcome in both groups. There was a significant improvement according to the self-assessment in health condition (0 to 100 scale) with a much larger gain in group A (28 vs 19patients, p<0.0001). Nevertheless, low cardiac output syndrome (12.3% vs 5.9%, p <0.01) and resuscitation (10.4% vs 5.6%, p <0.05) were more frequently seen in group A, contributing to a higher mortality at 30days (14.3% vs 7.2%) and 1 year (33.7% vs 18.1%, p <0.001). Inconclusion, this real-world registry demonstrated a comparably high success rate for patients with severe reduced LVEF and an early improvement in functional status as demonstrated by substantial benefit, despite a doubled postprocedural mortality.

Outcomes of Open Heart Surgery

Outcomes of Open Heart Surgery

Clinical outcomes of open heart surgery in patients with atopic dermatitis

Atopic dermatitis is a skin condition often complicated by colonization with Staphylococcus aureus, which increases the risk of infective endocarditis, skin cellulitis and osteomyelitis. Positive cultures for Staphylococcus aureus are obtained from 70% to 80% of wounds in patients with mediastinitis. Thus sternotomy carries increased risk of mediastinitis in patients with atopic dermatitis. We retrospectively reviewed 25 patients with atopic dermatitis who underwent cardiac surgery via a median sternotomy or thoracotomy from January 1997 to September 2010 at our institution. Postoperative mediastinitis due to methicillin-resistant Staphylococcus aureus was found in 3 patients who had a median sternotomy. They were ultimately discharged in good condition. No mediastinitis occurred in patients undergoing thoracotomy. Mediastinitis may occur due to direct exposure of the bone marrow to methicillin-resistant Staphylococcus aureus in patients with atopic dermatitis whose skin is colonized with such bacteria. Thoracotomy may be a better surgical approach in patients with atopic dermatitis who require thoracic surgery.

The Outcome of Open Heart Surgery for Congenital Heart Disease in Infants With Low Body Weight Less Than 2500 g

Although the outcome of neonatal cardiac surgery has dramatically improved, low body weight (LBW) is still considered an important risk for open heart surgery. The factors contributing to poor outcomes in LBW infants, however, are still unclear. We investigated risk factors for poor outcomes in infants weighing <2500 g who underwent surgical correction with cardiopulmonary bypass (CPB). From January 1995 to December 2009, 102 consecutive patients were included in this study. Median age and body weight at the time of surgery was 19 (range 1 to 365) days and 2.23 kg (range 1.3 to 2.5), respectively. Corrective surgery was performed on 75 infants. The median follow-up duration was 45.03 months (range 0.33 to 155.23). There were 23 (22.5%) hospital mortalities. Emergency surgery and low cardiac output (LCO) were associated with early mortality; however, body weight, Aristotle basic complex score, and type of surgery was not. Early morbidities, including delayed sterna closure, arrhythmia, and chylothorax, occurred in 39 (38.2%) infants. The overall actuarial survival rate at 10 years was 74.95% ± 4.37%. In conclusion, among infants weighing <2500 g who underwent open heart surgery with CPB, perioperative hemodynamic status, such as emergency surgery and LCO, strongly influenced early mortality. In contrast, LBW itself was not associated with patient morbidity or mortality.

Comparisons of Cardiac Surgery Outcomes in Jehovah’s Versus Non-Jehovah’s Witnesses

Jehovah's Witnesses is a Christian faith whose members will not accept blood or blood products under any circumstances on the basis of religious grounds. To date, no comparative studies have evaluated the outcome of open heart surgery in Jehovah's Witnesses compared with patients who accept the transfusion of blood products. The present study was conducted to systematically compare the operative mortality and early clinical outcome after open cardiac surgery in Jehovah's Witnesses versus non-Jehovah's Witnesses. From January 1990 to July 2004, 49 Jehovah's Witness patients underwent cardiac surgery, and their data were compared with those of a contemporaneous control group of 196 non-Jehovah's Witnesses. Logistic regression analysis was used to compare operative mortality, postoperative intensive care unit care, and hospital length of stay between the 2 groups, controlling for preoperative risk factors. The Jehovah's Witnesses were matched in a 1:4 ratio to the non-Jehovah's Witnesses using propensity scores. No significant differences were identified in unadjusted stroke (p = 0.5), acute myocardial infarction (p = 0.6), new-onset atrial fibrillation (p = 0.106), prolonged ventilation (p = 0.82), acute renal failure (p = 0.70), and hemorrhage-related reexploration (p = 0.59) rates between the 2 groups. On multivariate analysis, Jehovah's Witnesses had operative mortality (odds ratio 0.66, 95% confidence interval 0.12 to 3.59, p = 0.63), intensive care unit stay (odds ratio 1.36, 95% confidence interval 0.46 to 3.97, p = 0.58), and postoperative length of stay (odds ratio 1.43, 95% confidence interval 0.92 to 2.20, p = 0.16) comparable to those of the non-Jehovah's Witnesses, after controlling for preoperative risk factors through matching. In conclusion, cardiac surgery in Jehovah's Witnesses is associated with clinical outcomes comparable to those of non-Jehovah's Witnesses by adhering to blood conservation protocols.

Peak blood lactate levels during cardiopulmonary bypass and post-operative outcome in open heart surgery

Peak blood lactate levels during cardiopulmonary bypass and post-operative outcome in open heart surgery

Outcome of elderly patients undergoing open-heart surgery in a developing country

To evaluate and compare the outcome of open-heart surgery in elderly patients with a concurrent group of younger patients in a developing country, data of all adult patients who underwent open-heart surgery during the period of 3 years from January 1999 to December 2001 were collected prospectively. Demographic data such as age and gender, other data such as preoperative diagnoses, comorbid illnesses, type of surgery, time of cardio-pulmonary bypass, length of stay and hospital outcome were recorded. The characteristics of patients above the age of 65 years were compared with a concurrent cohort of patients aged less than 65 years. One hundred and forty-five adult patients underwent open-heart surgeries in 3 years, and the overall mortality rate was 4.8%. The much common surgeries were coronary artery bypass grafting, valve repair/replacement surgery and surgery for adult congenital heart diseases. Forty-five (31%) patients were above the age of 65 years. The mortality rate was 2.2% for patients who were aged 65 years and above, in comparison with that of the concurrent cohort of younger patients (6%). This was probably because of more number of surgeries for congenital heart diseases in the latter group. However, even with other surgeries such as coronary artery bypass grafting, the elderly group of patients did equally well as the younger group. Elderly patients tolerate cardiac surgery well, and age should not be an exclusive criterion to decide against open-heart surgery.

Late outcomes of open heart surgery in patients 70 years or older

Background. The purpose of this study is to examine the long-term survival and quality of life, including the influence of comorbidities, in patients 70 years of age and over after open heart surgery.Methods. This was a retrospective study of 401 consecutive patients, who were 70 years of age or older at the time of surgery. Survival and quality of life of these patients were measured at 6- to 8-year follow-up.Results. The 5-year survival rate was 85%, and was comparable with the age- and gender-matched West Virginia population. Survival declined with increasing preexisting comorbidities. Of the 176 respondents completing the quality of life (SF-36) survey, most scores were similar to or substantially better than the US population normative scores for individuals 70 years of age or older.Conclusions. Survival rates vary by presence or absence of specific comorbid conditions. Quality of life in the appropriately selected elderly after open heart surgery appears to be similar to the US population normative scores.

Open-heart surgery in patients requiring chronic hemodialysis.

The management and outcome of open-heart surgery in 31 patients requiring chronic hemodialysis because of end-stage renal failure are reviewed. The reasons for surgery were coronary artery disease (20 cases), mitral valvulopathy (5, including 3 with tricuspid insufficiency), aortic valvulopathy (5, including 2 with coronary artery disease) and perforation of an aortic aneurysm into the left upper lung lobe. Surgery was elective in all but the last case. Apart from double venous cannulation to avoid potassium overload after cardioplegia, and hemofiltration in the extracorporeal circulation permitting removal of 1,500-2,000 ml fluid during bypass, procedure was routine. Postoperatively fluids were restricted and serum potassium levels were not allowed to exceed the known preoperative maximum. Four patients required catecholamine support for 3-10 hours. Thirty were weaned from the respirator after 8-41 (mean 16) hours. The one perioperative death was due to complications associated with post-bypass administration of protamine. Dialysis was restarted 20-69 (mean 32) hours postoperatively. With appropriate management of fluid balance and potassium, open-heart surgery in dialysis-dependent patients need not carry heightened risk.

Analogical Reasoning and Postoperative Outcome

We investigated whether postoperative outcome of open heart surgery is related to preoperative cognitive dysfunction. Patients ill enough to require open heart surgery frequently have gravely compromised circulation and, hence, possible brain damage. The Conceptual Level Analogy Test (CLAT), a new, rigorously constructed analogy test, was used to measure cognitive dysfunction. The results indicated that the CLAT, aministered preoperatively to open heart surgery patients, differentiated between patients having different types of postoperative outcome. A significant relationship between type of surgical procedure and poor postoperative outcome was also found; cardiac valvular surgery patients had significantly worse outcome than coronary bypass surgery patients. The incidence of good outcome (survival with no psychiatric complications) was 28% for cardiac valvular surgery patients with extremely poor preoperative CLAT scores, but 74% for valvular surgery patients with higher preoperative CLAT scores.

Respiratory Care Following Open Heart Surgery

Respiratory care of patients undergoing open heart surgery should begin in the preoperative period. Patients must stop smoking, and if obese they are encouraged to lose weight. Pulmonary infection is treated and secretions must be eliminated. Postoperative hypoxemia, which is an expected event following anesthesia and surgery, is aggravated by circulatory instability and pulmonary complications. Following open heart surgery pulmonary complications such as atelectasis, congestion, edema, postperfusion lung, pneumothorax, pleural effusion, and hemothorax are common. Respiratory care should be planned to avoid these complications and to treat them promptly should they occur. Routinely every patient is mechanically ventilated for at least 12 to 18 hours following surgery. The type of ventilator used and its parameters are adjusted according to the clinical condition of the patient to maintain adequate oxygenation and to prevent any respiratory acidosis. When indicated, PEEP is applied to improve arterial oxygenation. Respiratory care is extended for at least 5 days after termination of artificial ventilation. Oxygen therapy is given with either a nasal catheter or a mask, according to the patient's need. IPPB and physiotherapy are continued until the patient shows no signs of pulmonary infection and is capable of effectively eliminating secretions. This routine management and extended postoperative respiratory care definitely contribute to the successful outcome of open heart surgery.