Cardiac Surgery Recovery Research Articles

심폐바이패스를 이용한 성인 심장수술 시 환자회복에 영향을 미치는 인자

We defined factors affecting the postoperative outcome in adult cardiac surgery with cardiopulmonary bypass (CPB). Thirty-two adult patients scheduled for elective cardiac surgery participated in this study. Levels of leukocyte, glutamic oxaloacetic transaminase (GOT), troponin-I (cTNI), interleukin-6 (IL-6), D-dimer and neuron-specific enolase (NSE) were significantly elevated, whereas platelet count declined in cardiac surgery with CPB. GOT and D-dimer levels at CPB-off each had a positive significant correlation significantly with 24 hrs-bleeding, total bleeding, mechanical ventilatory assist time, ICU stay time and length of hospitalization. BUN levels at CPB-off were directly related to total bleeding, mechanical ventilatory assist time, ICU stay time and length of hospitalization. Platelet count at CPB-off was inversely related to mechanical ventilatory assist time, ICU stay time and length of hospitalization. Creatinine concentration at CPB-off interrelated positively with mechanical ventilatory assist time and ICU stay time. NSE levels at CPB-off had a positive relationship with postoperative 24 hrs-bleeding. The length of hospitalization was prolonged proportionally to the elevation of cTNI levels in cardiac surgery. Aortic cross-clamping and total CPB times also related with increase of 24 hrs and total bleeding volumes and the length of hospitalization. IL-6 and ET-1 had no mutual relation with any postoperative outcome. These data suggest that GOT, BUN, creatinine, D-dimer and platelet levels are the most important factors affecting postoperative outcomes and patient's recovery in adult cardiac surgery with CPB.

Cardiac cycle efficiency correlates with pro-B-type natriuretic peptide in cardiac surgery patients

Cardiac cycle efficiency (CCE) can be calculated by the pressure recording analytical method (PRAM), a less invasive pulse-contour system that can provide beat-to-beat monitoring of cardiac output (CO). CCE is an innovative parameter that ranges from -1 to +1, with -1 being the worse and +1 the best possible efficiency of the cardiac cycle (that is, better ventricular–arterial coupling). Pro-BNP-type natriuretic peptide (pro-BNP) is predominantly secreted from the cardiac ventricles in response to increases in ventricular wall stress (VWS). Pro-BNP has been shown to correlate with myocardial hypertrophy and dysfunction [1]. We studied the feasibility of the CCE by PRAM when compared with pro-BNP to monitor the VWS and myocardial impairment and recovery in cardiac surgery.

Impact of the opening of a specialized cardiac surgery recovery unit on postoperative outcomes in an academic health sciences centre

It is controversial as to whether cardiac surgery patients are optimally managed in a mixed medical-surgical intensive care unit (ICU) or in a specialized postoperative unit. We conducted a prospective cohort study in an academic health sciences centre to compare outcomes before and following the opening of a specialized cardiac surgery recovery unit (CSRU) in April 2005. The study cohort included 2,599 consecutive patients undergoing coronary artery bypass grafting (CABG), valve and combined CABG-valve procedures from April 2004 to March 2006. From April 2004 to March 2005 (year 1) all patients received postoperative care in mixed medical-surgical ICUs at two different sites staffed by critical care consultants, fellows and residents. From April 2005 until March 2006 (year 2) patients were cared for in a newly-established CSRU on one site staffed by cardiac anesthesiology fellows, a nurse practitioner and consultants in critical care, cardiac anesthesiology and cardiac surgery. The effect of this change on in-hospital mortality, the incidence of ten major postoperative complications, postoperative ventilation hours, readmission rates and case cancellations due to a lack of capacity was assessed using Chi-square or Wilcoxon tests, where appropriate. Coronary artery bypass grafting, valve and combined CABG-valve mortality rates were similar in years 1 and 2. There was a significant reduction in the composite major complication rate (16.3% to 13.0%, P=0.02) and in median postoperative ventilation hours (8.8 vs 8.0 hr, P=0.005) from year 1 to 2. On multivariable logistic regression analysis, the pre-merger interval (year 1) was a significant independent predictor of the occurrence of death or major complications. A specialized CSRU with a multi-disciplinary consultant model was associated with stable or improved outcomes postoperatively, when compared to a mixed medical- surgical ICU model of cardiac surgical care.

Cardioprotection with Volatile Anesthetics: Mechanisms and Clinical Implications

Cardiac surgery and some noncardiac procedures are associated with a significant risk of perioperative cardiac morbid events. Experimental data indicate that clinical concentrations of volatile general anesthetics protect the myocardium from ischemia and reperfusion injury, as shown by decreased infarct size and a more rapid recovery of contractile function on reperfusion. These anesthetics may also mediate protective effects in other organs, such as the brain and kidney. Recently, a number of reports have indicated that these experimentally observed protective effects may also have clinical implications in cardiac surgery. However, the impact of the use of volatile anesthetics on outcome measures, such as postoperative mortality and recovery in cardiac and noncardiac surgery, is yet to be determined.

Gender and short-term recovery from cardiac surgery.

There has been a lack of agreement regarding whether women have poorer outcomes than men following cardiac surgery. To examine the effect of gender on early recovery from cardiac surgery. Using a prospective descriptive design, 60 men and 60 women who had coronary artery bypass and/or valve surgery completed the study by participating in interviews in the immediate preoperative period and monthly through the third postoperative month. Measures of life quality, life satisfaction, expected/perceived recovery, functional status, global health status, and social support were examined. Preoperatively, women were more functionally limited (p = 0.019), and reported lower life satisfaction (p = 0.001) and social support (p = 0.006), than men. At 3 months postoperatively, there were few significant differences in outcome measures though women continued to report lesser social support (p = 0.002); women realized significantly greater improvement than men in functional status (p = 0.008); and neither age nor gender consistently predicted recovery. Recent studies focusing on gender differences in cardiac surgery recovery indicate fewer differences between men and women than once thought. However, the differences identified in this study (women's significantly greater improvement in functional status, lesser social support, and differences in the nature of work to which women return following their surgery) warrant concern and attention in clinical practice.

Establishing a Cardiac Surgery Recovery Unit within the Post Anaesthesia Care Unit

At the Austin & Repatriation Medical Centre (A&RMC) an innovative approach was taken to improve the reliability of ICU bed availability for elective cardiac surgery patients. A cardiac surgery recovery unit (CSRU), a dedicated three bed area, was established within the Post Anaesthesia Care Unit (PACU) so as to deliver care to a group of patients that had previously been provided in the Intensive Care Unit (ICU). Derived benefits arising from this initiative include a reduction in the number of cardiac surgery cancellations for want of ICU beds, reduced length of stay of patients in the CSRU and in the Medical Centre, and an improvement in the level of knowledge and skills of PACU nurses in relation to caring for the specific needs of acutely ill patients.

Great Expectations: Perceived Social Support in Couples Experiencing Cardiac Surgery

This study compares patient and spousal perceived support during the cardiac surgery recovery period (1 and 3 months after surgery) and explores the effects of social support on patient/spouse subjective mood states. Significant differences in levels of perceived social support were reported by patients and spouses over time. Social support buffered the impact of caregiving burden on mood disturbance for caregiving spouses but did not significantly impact physical or mental health outcomes for patients.