Cardiothoracic Surgery

The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications. From March, 2010 to March, 2012, 53 LVADs (50 Heart Mate II and 3 Heart Ware) were implanted in patients in our department. UFTA was successfully performed (LVAD ultra ) in 13 patients. After propensity score matching, we compared the LVAD ultra group with a matched group (LVAD match ) receiving conventional anesthesia management. Patients in the LVAD ultra group had significantly lower incidences of pneumonia (p = 0.031), delirium (p = 0.031) and...

Cardiac surgery in Jehovah's Witnesses may be challenging during the operation and postoperative period given their refusal of blood products. The aim of this study was to document our center's experience with Jehovah's Witnesses undergoing major cardiac surgery and to compare surgical outcomes with a matched control group. We retrospectively reviewed the demographic, perioperative, and in-hospital postoperative data for 31 Jehovah's Witness patients undergoing surgery from 1991 to 2012 and compared findings with a control group of 62 patients of the same sex and age, who underwent the same type of operations in the same period. Early mortality, major in-hospital morbidity, laboratory findings, and hospital stays were compared between groups. Demographic data were similar between groups, except that more patients in the Jehovah's Witness group had extracardiac arteriopathy compared with controls (p = 0.04). There was no difference in predicted mortality, calculat...

A 71-year-old man with a history of heart failure due to nonischemic cardiomyopathy, a left ventricular ejection fraction of less than 20%, hypertension, atrial fibrillation, and type 2 diabetes presented with substernal chest pressure of 1-hour duration, radiating to his left arm and occurring at rest. The electrocardiogram (ECG) at presentation revealed atrial fibrillation: concave upward ST-segment elevations of more than 1 mm in the inferior leads, more prominent in lead III than lead II, along with reciprocal ST-segment depressions in the anterior precordial leads. This was suggestive of an acute inferoposterior myocardial infarction (MI), likely from complete occlusion of the right coronary artery (RCA). The coronary angiogram (Figure 1A) confirmed this finding. The left main, the left anterior descending, and the left circumflex coronary arteries were normal. A percutane-ous coronary intervention (PCI) of the mid-RCA occlusion just distal to the right ventricular branch was performed. After the PCI, the chest pain resolved, but the patient's blood pressure was 90/60 mm Hg. Another ECG (Figure 1B) demonstrated resolution of the ST-segment elevations in the inferior leads with a new rSR′ pattern with concave upward ST-segment elevations in leads V 1 to V 3 .

This presentation was prepared by RUTAYISIRE François Xavier and ISHIMWE Diane, Medical students in Year 4(Doctorate 2) at University of RWANDA school of medicine and Pharmacy, Department of Medicine and Surgery. we did the work under supervision of Dr Ntakiyiruta Georges,Mmed,FCSECSA

Un tema que preocupa en gran medida a los sistemas de salud, además de la batalla frente al diagnóstico positivo, son las secuelas ocasionadas por el SARS-CoV-2, ya que según se ha reportado, puede afectar al corazón, riñones, intestino, sistema vascular e incluso al cerebro, pero se resaltara en el presente documento las secuelas pulmonares.

Muchas personas experimentan síntomas persistentes y una disminución en la calidad de vida relacionada con la salud después de la enfermedad por coronavirus 2019 (COVID-19). Los estudios existentes se han centrado en  personas hospitalizadas de 30 a 90 días después del inicio de la enfermedad y han informado síntomas hasta 110 días después de la enfermedad.

Las secuelas a más largo plazo en pacientes ambulatorios no han sido bien caracterizadas. Entre los supervivientes de COVID-19 se ha informado de un espectro de manifestaciones pulmonares, que van desde disnea (con o sin dependencia crónica de oxígeno) hasta destete difícil del ventilador y daño pulmonar fibrótico. Al igual que los supervivientes del síndrome de dificultad respiratoria aguda (SDRA) de otras etiologías, la disnea es el síntoma persistente más común más allá del COVID-19 agudo.

Hasta 2 meses después de la aparición de los síntomas, dos tercios de los adultos con COVID-19 no crítico tenían quejas, principalmente anosmia / ageusia, disnea o astenia. Un seguimiento médico prolongado de los pacientes con COVID-19 parece fundamental, sea cual sea la presentación clínica inicial. Los síntomas posteriores al COVID-19 agudo son comunes y pueden predecirse por factores durante la fase aguda de la enfermedad. La fatiga y los síntomas neuropsiquiátricos ocuparon un lugar destacado.

Se sabe que los pacientes con la indicación de la ventilación mecánica en el paciente con COVID19 es la falla respiratoria y posterior a sus salidas, se ven secuelas desde los 90 a los 180 días. Pero se es claro que la vida se prioriza versus las desventajas menores que se presentan al finalizar la ventilación mecánica que permitió no llegar al colapso pulmonar y la muerte.

Se observaron cambios fibróticos en la tomografía computarizada del tórax, que consisten principalmente en reticulaciones o bronquiectasias por tracción, con rangos de tiempo de 3 meses después del alta hospitalaria en aproximadamente el 25 y el 65% de los supervivientes de casos leves, moderados, sin dejar de lado las estimaciones de prevalencia de las secuelas de COVID-19 pos aguda de estos estudios sugieren que los pacientes con mayor gravedad de COVID-19 agudo (especialmente aquellos que requieren una cánula nasal de alto flujo y ventilación mecánica no invasiva o invasiva) tienen el mayor riesgo de Complicaciones pulmonares a largo plazo, que incluyen deterioro persistente de la difusión y anomalías pulmonares radiográficas (como fibrosis pulmonar).

Secuelas pulmonares: Su médico puede sugerir una espirometría, a fin de valorar la curación de los infiltrados pulmonares intersticiales y valorar si quedan secuelas de fibrosis pulmonar. También se sugiere una radiografía de tórax y el mejor tiempo es de 3 a 6 meses ante el alta, de acuerdo a seguimiento, criterio médico.

CONTINÚA…..

VER AQUÍ EL ARTÍCULO COMPLETO ➤ Secuelas pulmonares-Rehabilitación Post-covid-19

FUENTE: Cleveland Clinic. Center for Excellence in Healthcare Communication*

LIvro institucional que descreve a criação deste importante serviço e estrutura dos Hospitais da Universidade de Coimbra, desde a sua criação até aos nossos dias. Destaca a acção do Prof. Norberto Canha, Prof. Manuel Antunes, e equipa médico-cirurgica que os auxiliou. Contém depoimentos de várias personalidades e foi editado pelos Amigos do Centro de Cirurgia Cardiotorácia no âmbito dos 25 anos de actividade daquele serviço

Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection.

Background: Worldwide people of all ages are affected by the Noncommunicable Diseases (N.C.D.) and it
is a leading cause of death globally. According to the World Health Organization (WHO), 41 million people
die due to noncommunicable diseases which is equal to 71% of all death globally in which cardiovascular
diseases are the most common cause for death. The International Institute of Population Sciences stated that
from 1990 to 2016, the contribution rate of mortality of cardiovascular diseases is increased by 34.3% in India.
The more common leading cause of cardiovascular diseases are Coronary Artery Disease (CAD) and Stroke,
also WHO says in 2017, CAD is the leading cause of death and which is 15.6%. To treat these critical
conditions of coronary artery disease patients should undergo cardiac surgery which is known as Coronary
Artery Bypass Grafting Surgery (CABG). According to the A.H.A., Cardiac Rehabilitation is a
comprehensive exercise, education and behavioural modification program design to improve the physical and
emotional condition of patients with heart disease. Early mobilization includes an active range of motion,
thoracic mobility, bedside sitting, chair sitting, hall ambulation (chair sitting). With all these techniques, there
are mechanical devices available to improve oxygenation they known as positive pressure devices such as
Acapella, Flutter, Bubble-PEP, RC-Cornet. Bubble P.E.P. also used to prevent pulmonary complications in
postoperative open-heart surgery patient. On the other hand, the therapist-made bubble-PEP device which is
made from inexpensive and easily accessible materials consisting of a container (e.g. bottle) and tubing.
Therefore, the bubble P.E.P. is relatively cheaper and readily accessible.
Aim: To compare the effect of BBPEP Device and Acapella on Oxygenation and PEFR among patients with
open-heart surgery.
Objectives:
1. To compare the effect of BBPEP Device and Acapella on FiO2 and SpO2 among patients with openheart surgery.
2. To compare the effect of BBPEP Device and Acapella on PEFR among patients with open-heart
surgery.
Methodology: The study done on 54 samples. Samples were randomly divided into two groups, i.e. BBPEP
and Acapella group. Both the group received intervention from P.O.D. 1 to 3 twice a day. FiO2, SpO2 and
PEFR were taken pre- and post-treatment in every session. Data were collected and analysis was done.
Statistical analysis: normality was checked by using Kolomogrov-Smirnov Test. Data did not pass the
normality test, so a non-parametric test was used for data analysis.
Result: There was no significant difference between both groups.
Conclusion: The BBPEP and Acapella is equally effective in improving oxygenation and PEFR in the patient
who undergo open-heart surgery.
Keywords: BBPEP, Acapella, PEFR, FiO2, SpO2, Open Heart Surgery

La posibilidad de inducir el desarrollo de cardiomiocitos en el corazón adulto es una estrategia prometedora en el tratamiento de enfermedades como la insuficiencia cardiaca, la hipertrofia o la cardiopatía isquémica. Así, en los últimos años, el número de publicaciones en esta área se ha multiplicado sin embargo el conocimiento parece no haber avanzado mucho, aun se requiere de más estudios y de implementar toda la evidencia en conjunto.

La terapia celular vincula múltiples procesos fisiológicos asociados a la interacción célula- matriz, lo que permite generar un tejido con la capacidad de responder al implante y de esta manera sustituir o regenerar los tejidos lesionados o isquémicos. El conocer las bases fisiopatológicas permite descubrir nuevas alternativas de tratamiento y mejorar el pronóstico y sobrevida de los pacientes.

Vasquez A. Review of JAMA Cardiology’s 2018 “Associations of Omega-3 Fatty Acid Supplement Use with Cardiovascular Disease Risks”. Video presentation (http://www.ichnfm.org/jama2018n3) and official transcript (https://www.academia.edu/35935996) 2018 February.

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, a...

The Toronto General Hospital, Division of Cardiovascular Surgery, has enjoyed an enviable history of academic achievement and clinical success. The foundations of this success: innovation, creativity and excellence in patient care continue to influence the current members of the division.

This systematic review examines the role pre-admission clinics (PACs) in the preparation of patients for surgery and whether there is an optimal skill-mix profile of nurses, doctors or professions allied to medicine (PAMs) for them. The stage pre-operatively which patients are assessed for admission is considered and the length of time patients can be expected to spend at PACs. The format of documentation offering optimal communication between PAC and ward/operating theatre is evaluated together with whether this alters repeat investigations ordered before surgery. Finally whether patients benefit from the information given at PACs and if this results in improved discharge-planning for the patient.
The original aim of most PACs appear to have been to achieve a reduction in post-admission cancellations of surgery; however, this single aim appears lost amongst the advantages of quality improvements offered to patients and the potential financial savings if day of admission surgery is implemented. PACs have become an essential part of quality surgical care, to admit a patient without knowing they are fit to proceed for surgery is wasteful of both human time and financial resources. Nursing appears to offer the most holistic option, particularly with nurses who practise advanced assessment skills within evidence-based protocols appear in other respects to be as effective as the doctors with whom they work.
The ideal time for the pre-admission assessment is between one and three weeks pre-operatively; however, this does not coincide with the optimal time for patient education and behaviour modification (smoking etc.) which should be at least six weeks prior to surgery. Multidisciplinary documentation offers significant advantages in terms of cross professional communication however traditional boundaries remain and implementation of integrated care plan’s can meet obstruction from some individuals. The investigations requested pre-operatively may be slightly higher in nurse-led PACs however they conform more closely to evidence based protocols. Patients are better prepared for discharge with a combination of education and assessment prior to surgery.

In this work modelling and control of Perfusion system is presented. The Perfusion system simultaneously
controls the partial pressures during Extra Corporeal Membrane Oxygenation (ECMO) support. The
main Problem in ECMO system is exchange of Blood Gases in the Artificial Lung (Oxygenator).It is a
highly Nonlinear Process comprising time-varying parameters, and varying time delays, it is currently
being controlled manually by trained Perfusionist. The new control strategy implemented here has a
feedback linearization routine with time-delay compensation for the Partial pressuresof Oxygen and
Carbon dioxide. The controllers were tuned robustly and tested in simulations with a detailed artificial
Lung (Oxygenator) model in Cardiopulmonary bypass conditions. This Automatic control strategy is
proposed to improve the patient’s safety by fast control reference tracking and good disturbance rejection
under varying conditions.