Results Of Open Heart Surgery Research Articles

Open Hart Surgery Experience of a High Volume Center During Pandemic

Objective: The aim of the study is to report the results of open heart surgery performed during the pandemic. Methods: One hundred eighty-five symptomatic patients were operated under a median sternotomy with a cardiopulmonary bypass in our pandemic hospital. They were all outpatient and were COVID-negative and strict precautions were taken. Results: 185 patients were referred to cardiovascular surgery for several type of cardiac operation. All patients were symptomatic due to primary cardiac disease. In-hospital mortality rate was seven times higher in those with Covid-19 (22.2%) while the non Covid-19 patients had a rate of (3.4%) (p<0.0001). Conclusion: Cardiac surgery is inevitable in symptomatic patients and can be done even with the risk of transmission and death. The patient, cardiac surgeon, and healthcare team should be aware of the ongoing contamination time.

Early results of open-heart surgery for acquired heart diseases in Ibadan, Nigeria

Background: Cardiovascular disease burden is disproportionately high in Sub-Saharan Africa (SSA) where resources to provide optimum care for cardiothoracic patients are still very limited. Previous reports of open-heart surgery from new centers in SSA have shown a preponderance of valvular heart disease in published series, with wide variations in reported morbidity and mortality. Objectives: We report on a series of patients who underwent open-heart surgery for acquired heart diseases to demonstrate pattern of disease, type of cardiac surgery done, and our results. Methods: We conducted a retrospective review of patients who had open-heart surgery for acquired heart diseases between October 2013 and November 2016. Data collected included demographics, presenting symptoms, indication for surgery, preoperative evaluation and preparation, operative procedure, postoperative complications, and follow-up. Statistical analysis was carried out descriptively using frequencies and percentages. Results: A total of 35 patients have undergone open-heart surgery between October 2013 and November 2016. The patients who had surgery for acquired heart disease were 17 (48.6%). These included valvular heart disease in 13 patients while the remaining patients had coronary artery bypass grafting (CABG) for ischemic heart disease. The mean age of patients who had valve replacement and CABG were 39 and 60 years, respectively. Parsonnet risk scoring was used with an average score of 8.5. Three (17.6%) patients were in good risk category while 7 (41.2%) patients each were in fair and poor risk categories. Postoperative complications included paravalvular leaks in two patients. There was no hospital mortality. Conclusion: Early results of valvular and coronary artery bypass surgeries from our center show good outcome comparable to global standards with zero hospital mortality and low morbidity. The result is aided by good case selection, adequate preparation, and teamwork.

Results of open heart surgery in Jehovah's Witness patients. Single centre experience.

AimEvaluation the results in patients from the religious community of Jehovah’s Witness (JW) undergoing open heart surgery at our institution.Material and methodsBetween September 2011 and March 2015, 21 patients with a religious background of the JW church underwent open heart surgery at our institution performed by the same surgical team. Mean age was 68.43 ±8.93 years. There were 13 (61.9%) female patients. Recombinant human erythropoietin was administered to every patient with a hemoglobin value < 12.0 g/dl. Nine patients undergoing isolated coronary artery revascularization were operated on without cardiopulmonary bypass. Seven patients underwent combined surgery and 5 patients underwent aortic valve replacement via ministernotomy. The mean follow-up time was 16.45 ±11.09 months (range: 1.67–44.3 months).ResultsMean baseline hematocrit serum level was 40.15 ±3.34% (range: 34.5–46.1%). Perioperatively the hematocrit serum levels decreased to the mean level of 29.89 ±4.31% (range: 21.4–36.3%). The mean hematocrit value at discharge was 30.85 ±3.59% (range: 23.5–38.4%). One death was observed in the perioperative period. Five (24%) patients suffered from sternum wound infection requiring vacuum-assisted therapy. During the follow-up period 1 patient died due to a non-cardiac related cause.ConclusionsAfter careful preoperative preparation the results of open heart surgery in JW were very good, including combined procedures. The decrease of hematocrit serum levels significantly characterizing the postoperative period was highly acceptable in this series. Nevertheless, the number of sternum wound infections was a limiting factor for prompt postoperative recovery.

Heart surgery in end-stage renal disease: is outcome worse for african american patients?

General results of open heart surgery in end-stage renal disease patients (ESRD) have been well-documented. However, it is unknown if the African American subgroup with known decreased access to advanced healthcare services and a higher prevalence rate of ESRD have a worse long-term survival after heart surgery. Thirty of 150 African American patients who underwent open heart surgery by a single surgeon at an urban community hospital between 1996 and 2010 were identified to have ESRD and were on chronic maintenance hemodialysis prior to surgery. Clinical and outcome data from both groups were retrospectively analyzed. There were no significant differences in the baseline demographic characteristics of the patients, but the ESRD cohort showed a significantly higher prevalence of peripheral vascular and cardiovascular diseases [P < 0.001]. Compared to the non-ESRD subjects, the predicted logistic EuroSCORE was 16.4% vs. 9.4%, [P < 0.001], while the observed 30 days operative mortality was 16.6% vs. 4.2% [P < 0.02], respectively. In isolated coronary artery bypass graft cases, operative mortality was 20.8% and 3.0%, respectively. The 5- and 10-year post-surgery survival was 40% and 25% vs. 72% and 57% [P < 0.01], respectively, in the ESRD and non-ESRD groups. Operative mortality and survival was worse in ESRD patients compared to non-ESRD patients based on their preoperative risk scores. Although the operative mortality of our ESRD patients was high, long-term survival was comparable to reports from both the United States Renal Data System and a Japanese ESRD cohort.

Analysis of open heart surgery in patients with liver cirrhosis

Open heart surgery in patients with liver cirrhosis is considered to be very risky, but the predictors of poor outcomes in such cases have not been established. We report the perioperative results of open heart surgery in patients with liver cirrhosis in our hospital. We reviewed the results of 13 cases in 12 patients with liver cirrhosis who underwent open heart surgery between January 2001 and December 2010. The Child-Turcotte-Pugh classification, the model for end-stage liver disease score, EuroSCORE, and perioperative data were used to identify risk factors for morbidity and mortality retrospectively. Ten patients had postoperative complications. Significant differences in morbidity were evident for Child-Turcotte-Pugh class, cardiopulmonary bypass time, and crossclamp time. Two patients died of liver failure, one at 40 days and the other at 2 years after surgery. Statistically significant differences in liver-related mortality were evident in the model for end-stage liver disease scores and serum cholinesterase levels. We concluded that a high Child-Turcotte-Pugh class was associated with increased morbidity. Cardiopulmonary bypass and crossclamp times were also related to high morbidity, while high model for end-stage liver disease scores and low serum cholinesterase levels predicted liver-related mortality.

慢性血液透析症例における開心術後遠隔成績―ＣＡＢＧ ｖｓ．弁置換術―

慢性血液透析症例における開心術後遠隔成績―ＣＡＢＧ ｖｓ．弁置換術―

Short- and long-term results of open heart surgery in patients with abdominal solid organ transplant.

Cardiac disease is a common cause of mortality and morbidity in patients with abdominal solid organ transplant. Improvement of the results of abdominal organ transplantation has contributed to an increasing pool of patients who require open heart surgery. We investigated short- and long-term results of open heart surgery in patients with functioning abdominal solid organ transplants. We retrospectively examined 60 patients (52.5 years in average) undergoing coronary artery bypass grafting and/or valve surgery since July 1988 after abdominal organ transplantation. There were 22 females (37%). They consisted of 46 kidney, nine kidney-pancreas and five liver recipients. Cardiac surgery was performed 68.9 months after transplantation. Preoperative serum creatinine level was 2.1 mg/dl, and 11 patients (18%) had creatinine level more than 3.0 mg/dl. Eleven patients (18%) were operated upon on non-elective basis. Twelve patients (20%) were not given stress-dose steroids postoperatively. Three patients died early after surgery (5.0%). Twenty-six major complications were seen in 17 patients (28%), including deterioration of renal function in seven (three patients required temporary hemodialysis), three major infections, two bleeding complications, and two strokes. No graft loss was encountered. No differences were seen in mortality and morbidity between patients with or without stress-dose steroids. Multivariate analysis identified cardiopulmonary bypass time (P<0.05) as a risk factor for operative death, preoperative creatinine level (P<0.05), cardiopulmonary bypass time (P<0.05) and the amount of fresh frozen plasma used (P<0.05) for major complication, non-elective surgery (P<0.01) for deterioration of renal function. Thirteen patients died and five kidney allografts failed late after surgery. Three- and 5-year patient and graft survivals were 70.8 and 66.8, 84.5 and 84.5%, respectively. Multivariate regression analysis identified female gender (P<0.05), body mass index (P<0.001) and non-elective surgery (P<0.001) as risk factors for late death, and preoperative creatinine level (P<0.05) for late graft loss. Open heart surgery can be performed with acceptable short- and long-term results in patients with functioning abdominal transplants. Stress-dose steroid may be unnecessary in selected patients. Aggressive use of open heart surgery in this patient population to avoid non-elective surgery may further improve early and late surgical outcomes.

Short and Long-term Results of Open Heart Surgery in Aortic Valve Disease

Background and Objectives:This study sought to investigate operative and late mortality in aortic valve surgery and to identify risk factors for operative and late mortality. Materials and Methods:We examined operative mode, operative and late mortality, and survival rate of aortic valve surgery performed at Asan Medical Center between June 1989 and December 1996. Results:227 patients (148 men) with a mean age 49±15 years underwent aortic valve surgery. Aortic valvular lesions were classified as dominant stenosis (n=66), dominant regurgitation (n=133), and balanced stenoinsufficiency (n=28) according to the echocardiographic findings. Surgical procedures were aortic valve replacement with mechanical prosthesis in 180 (79%) and with bioprosthesis in 27 (12%) and aortic valve repair in 20 (9%). The overall operative mortality was 4.8%. Bacterial endocarditis and long bypass time were independent factors associated with high operative mortality (p<0.05). During follow up (mean 33±24 months) of operative survivors, there were 9 late deaths, 12 redo operations, and 11 clinical events (bacterial endocarditis, stroke, major bleeding, and admission for heart failure). There was no single identifiable risk factor for late mortality but age was significantly associated with development of clinical event and late mortality (p<0.05). One-, Three-, and Seven-years survival rate after successful operation were 98±1%, 96±2%, and 92±3%, respectively. Late clinical event-free survival rate was 67±8% at seven years after aortic valve surgery. Conclusions:Aortic valve surgery could be done with low operative and late mortality. Complications related with bacterial endocarditis and long-term anticoagulation therapy following valve replacement surgery still remained high, which needs further improvement. (Korean Circulation J 1998; 28(9):1509-1517)

Evaluation of new clinical criteria for the diagnosis of infective endocarditis

purpose: The clinical diagnosis of infective endocarditis (IE) can be difficult. A new diagnostic schema for IE (the Duke criteria) has been proposed, utilizing clinical, microbiologic, and echocardiographic data. We evaluated the Duke criteria in a cohort of prospectively enrolled patients suspected of having IE and compared the diagnostic efficiency of these criteria with the previously published criteria of von Reyn. patients: Sixty-three febrile patients with suspected IE at a nonreferral, municipal hospital were evaluated. All patients had the following parameters defined: the presence and nature of underlying heart disease; recent abuse of intravenous drugs; peripheral stigmata of IE; blood culture results; findings on two-dimensional transthoracic and transesophageal echocardiography (TTE, TEE); and the results of open heart surgery. results: Twelve of 63 patients underwent open heart surgery, at which time IE was pathologically confirmed in 10 patients and excluded in 2 patients. All 10 patients with pathologically confirmed IE were classified as “clinically definite” by Duke criteria, whereas 5 of 10 were rejected by von Reyn criteria (p <0.05). Among the remaining 51 patients suspected of IE and evaluated by both von Reyn and Duke clinical criteria, significantly more cases were classified as “definite” IE by Duke criteria than by von Reyn criteria (p < 10 −5). Similarly, significantly fewer cases were rejected as IE by the Duke criteria as compared with the von Reyn criteria (p < 10 −6). Duke criteria were also significantly better at diagnosing IE than von Reyn criteria in the following clinical settings: suspected right-sided IE (p < 0.01); suspected left-sided IE (p = 0.014); suspected culture-negative IE (p < 10 −2); and IE complicating Staphylococcus aureus or viridans streptococcal bacteremias (p < 10 −5; p < 0.05, respectively). Among 30 cases defined as clinically definite by the Duke criteria, the presence of blood culture positivity and echocardiographically defined vegetations was important in this classification of 77% and 57% of cases, respectively. Among the 17 patients in the clinically definite category with vegetative endocarditis observed by echocardiography, 7 (41%) had vegetations defined only by TEE. conclusion: The Duke criteria are superior to the von Reyn criteria for the clinical diagnosis of IE, predominately reflecting use of two-dimensional echocardiographic demonstration of valvular vegetations in the Duke schema.

主題III-11 連合弁膜症,とくに大動脈弁・僧帽弁弁膜症の手術遠隔成績

主題III-11 連合弁膜症,とくに大動脈弁・僧帽弁弁膜症の手術遠隔成績

主題III-1-6 高年者(50才以上)弁膜症例に対する外科治療成績

主題III-1-6 高年者(50才以上)弁膜症例に対する外科治療成績

Results of open heart surgery in the septuagenarian.

Open heart surgery has been extended to the septuagenarian. At the Long Island Jewish-Hillside Medical Center, 42 patients 70 to 79 years old underwent 43 open heart procedures in the past 7 years. Their average age was 73 years and 62% were male. Eighteen underwent aortic valve replacement; 7 had mitral valve replacement; 18 had coronary bypasses (3 with valve replacement); exploration for pulmonary embolism was done in 1; 1 patient had tricuspid replacement with mitral commissurotomy; 17% (7/42) died during hospitalization or within 30 days of surgery. Mean follow-up is 25 mo., and an additional 19% (8/42) have died at an average of 27 mo. after surgery. Open heart surgery is feasible for the elderly, but at an increased risk when compared to the younger patient submitted to the same procedure.

A review of the effect of previous operations on the results of open-heart surgery.

The results of open-heart surgery in a group of 50 patients who had had previous cardiac operations were analysed and compared with the results in a group of 50 patients having their first operation. The hospital mortality in the re-operated group was 22% and that in the control group was 8%. Postoperative morbidity was also increased in the re-operated group. Technical hazards related to the previous operation did not contribute to the increased operative mortality, which was considered to be due to the more advanced disease present in these patients.

RESULTS OF OPEN-HEART SURGERY IN PATIENTS WITH PULMONIC STENOSIS AND INTACT VENTRICULAR SEPTUM. A REPORT OF 108 CASES.

A group of 108 consecutive patients with moderate-to-severe pulmonic stenosis and intact ventricular septum, operated upon by means of a pump oxygenator between the years of 1957 and 1961, has been presented. The total mortality of the series was 2.77 per cent, and an additional 1.8 per cent were left with residual neurologic complications. Fifty per cent of the patients showed an excellent result as indicated by normal electrocardiograms or right ventricular pressure below 65 mm. Hg by cardiac catheterization. An additional 26 per cent had good results as indicated by the absence of symptoms, normal x-rays, mild electrocardiographic changes, and in three instances, slight right ventricular hypertension. Ten per cent had unsatisfactory results based on significant residual abnormalities in the electrocardiograms, x-rays, or postoperative catheterization data.

IMPORTANCE OF STANDARDS OF CARE FOR PATIENTS WITH CARDIOVASCULAR PROBLEMS

AN IMPORTANT consideration in regard to standards of care for children with cardiovascular problems is that the pediatricians have the responsibility for organizing a good diagnostic and surgical team. A good anesthesiologist, a competent surgeon, good nursing care, and keen postoperative observation for early signs of complications are all essential to success. The pediatricians cannot regulate the surgeon, but the standards set can require that the surgeons have met their own standards before they have charge of the pediatric surgical program. The superb results of open-heart surgery as quoted by Dr. Kirklin from the Mayo Clinic are unfortunately not a universal experience and hence recommendations for surgery in a given area must be based on local operative results. The responsibility for operation rests clearly with the pediatrician and the pediatric cardiologist. The family grants permission for operation but their consent is given on the basis of the advice they receive from the doctor. If operation is not indicated or the risk too high, ours is the responsibility to persuade child and parent not to have an operation. To do right by the child and the family the diagnosis should be accurate, the indications for surgery should be clear, and the family should fully understand the situation. Even if the odds are overwhelmingly in favor of a successful operation, for any one patient the odds are one to one between life and death. Cardiac operations should be undertaken only to correct or alleviate an abnormality of the heart. Indeed, the pediatrician must be certain that the child's complaints are related to the cardiac condition. The tendency is a natural one to assume that two unknowns go together.

Results of Open Heart Surgery Without Donor Blood Prime in Pump-Oxygenator

Results of Open Heart Surgery Without Donor Blood Prime in Pump-Oxygenator

Results of Open Heart Surgery with Elective Cardiac Arrest by Potassium Citrate in Patients with Congenital and Acquired Heart Disease

Elective cardiac arrest, accomplished by perfusion of potassium citrate solution into the coronary circulation, has made possible excellent surgical exposure of intra-cardiac structures during open cardiotomy in 80 patients with a wide variety of congenital and acquired lesions. The cardioplegic effect of potassium was reversed by perfusing the coronary arteries with oxygenated blood. In no instance was death or surgical failure attributable to the use of cardiac arrest. Forty-five patients have survived. Reasons for death have been stated within the limits of our present knowledge. The post-operative status of surviving patients has been evaluated on the basis of clinical findings and, when possible, by heart catheterization and cinecardioangiography six to 14 months after operation. Anatomic correction with restoration of normal function may be anticipated in patients with atrial or ventricular septal defects, provided complete absence of the septum is not encountered. Severe pulmonary hypertension is not a contra-indication to closure of septal defects, if there is a large left to right shunt with increased pulmonary flow. In patients with Tetralogy of Fallot, inadequate closure of the ventricular septal defect has been found in most instances when a prosthesis has not been incorporated into the defect. These patients have shown clear-cut evidence of functional improvement, with increased pulmonary blood flow and relief of arterial hypoxemia, but anatomic correction and restoration of normal cardiovascular dynamics has usually not been obtained. Experience with this small group of patients emphasizes the need for further refinements in diagnosis, surgical technique, artificial perfusion and post-operative management before the ultimate potential of open heart surgery may be fully realized.

The hemodynamic results of open heart surgery: Preliminary report

The hemodynamic results of open heart surgery: Preliminary report