358,418 research outputs found

    Permanent atrial fibrillation ablation surgery in patients with advanced age

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    Background: Even if permanent atrial fibrillation (pAF) is a frequent concomitant problem in patients undergoing open heart surgery and particularly in those with advanced age, data of pAF ablation surgery in older aged patients are scarce. This study was performed to assess early and late results of combined open heart surgery and pAF ablation procedures in patients with advanced aged, compared to young patients. Material and Methods: A selective group of 126 patients (Group A: age ≥70 [76.4±4.8] years, n=70; Group B: age <70 [62.0±6.2] years: n=56) with pAF (≥6 months) underwent either monopolar (Group A, B: n=51 vs. n=44) or bipolar (Group A, B: n=19 vs. n=12) radiofrequency (RF) ablation procedures concomitant to open heart surgery. Regular follow-up was performed 3 to 36 months after surgery to assess survival, New York Heart Association (NYHA) class and conversion rate to stable sinus rhythm (SR). Results: Early mortality (<30 days) was 2.9% in Group A (Group B: 0%), cumulative survival at long-term follow up was 0.78 vs. 0.98 (p=0.03) and NYHA-class improved significantly in both groups, particularly in cases with stable SR. At 12-months follow-up 73% of Group A patients were in stable SR (Group B 78%). Conclusions: Concomitant mono- and bipolar RF ablation surgery represents a safe option to cure pAF during open heart surgery with a very low risk, even in patients with advanced age

    Open Heart Surgery

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    Hemoglobin Level Decrease after Open Heart Surgery in a Tertiary Hospital in Indonesia

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    Background: Open heart surgery is usually performed by connecting the heart to a cardiopulmonary bypass (CPB) machine. The use of the CPB machine may decrease the hemoglobin level and a very low hemoglobin levelcould cause seriouscomplications.This study aimed to explore the decrease in hemoglobin level after open heart surgery.Methods: A cross-sectional retrospective descriptive study was conducted on medical records of patients underwent coronary artery bypass graft (CABG) surgery and heart valve surgery in a tertiary hospital in Indonesia in  2018. The total sampling method was deployed to all medical records of patients underwent CABG surgery (n=25) and patients underwent heart valve surgery (n=3).Results: The decrease in hemoglobin level among young-adult female patients after heart valve surgery was 6.8 g/dl. The average decrease in mid-adult male and female patients after CABG surgery were 6 g/dl and 5.8 g/dl, respectively, and, after the heart valve surgery, the levels were 8.5 g/dl and 5.4 g/dl, respectively. The average decrease in Hb level among late-adult male and female patients after CABG surgery was 6.1 g/dl and 5.4 g/dl, respectively.Conclusion: Hemoglobin level decreases after an open heart surgery. Therefore, observation on the hemoglobin level to prevent complications and to facilitate early treatment is necessary

    Cognitive Outcomes and Functional Performance for Patients After Open Heart Surgery

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    Context: Open heart surgery is a lifesaving procedure for patients who need coronary artery bypass graft (CABG) and heart valve replacement or repair (HVR). However, it also carries a risk of cognitive and functional performance injuries. Between 30% to 60% of patients undergoing open heart surgery worldwide are at high risk of cognitive and functional performance injuries. Aim: The study aimed to assess cognitive outcomes and functional performance of patients after open heart surgery. Methods: A descriptive exploratory design was applied to achieve the aim of this study on a purposive sample of 103 adults who were scheduled for elective open-heart surgery (CABG and valve replacement or repair). Montreal Cognitive Assessment (MOCA); Physical Self-Maintenance Scale (Activities of Daily Living) (PSMS) tests were used to determine the effect of cardiac surgery on cognitive outcomes and functional performance abilities of patients undergoing cardiac surgery. Both scales were used twice for each patient (preoperative and postoperative). Results: The current study shows a statistically significant deterioration in all cognitive functions (visuospatial &amp;executive function, naming, short-term memory recall task, attention, language, abstraction, orientation) (p=0.000). A total cognitive score reveals that 68% of the patients had normal cognitive function before open heart surgery, significantly decreasing to 55.3% after surgery. The functional outcomes measured by the assessment of activity of daily living shows that 100% of patient were independent before open heart surgery and significantly decreased to 74.8% postoperatively. Conclusion: It can be concluded that open heart surgery impacts cognitive functions, particularly in domains of visuospatial and executive function, memory, and attention. Besides, the everyday functional performance includes toileting, feeding, dressing, grooming, physical ambulation, and bathing). Instrumental activities of daily living (IADL), which include the ability to use the telephone, shopping, food preparation, housekeeping, laundry, away for transportation, responsibility for following their medication regimens, and ability to handle finances, were also affected. Nurses caring for patients undergoing open heart surgery should consider cognitive limitations when giving them health education and discharge instruction, their readiness to learn should be considered before any educational event. Further studies should be carried out to identify the factors that may contribute to the impairment of cognitive function and functional performance for patients undergoing cardiac surgery

    Outcome of patients undergoing open heart surgery at the Uganda heart institute, Mulago hospital complex

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    Background: Heart disease is a disabling condition and necessary surgical intervention is often lacking in many developing countries. Training of the superspecialties abroad is largely limited to observation with little or no opportunity for hands on experience. An approach in which open heart surgeries are conducted locally by visiting teams enabling skills transfer to the local team and helps build to build capacity has been adopted at the Uganda Heart Institute (UHI).Objectives: We reviewed the progress of open heart surgery at the UHI and evaluated the postoperative outcomes and challenges faced in conducting open heart surgery in a developing country.Methods: Medical records of patients undergoing open heart surgery at the UHI from October 2007 to June 2012 were reviewed.Results: A total of 124 patients underwent open heart surgery during the study period. The commonest conditions were: venticular septal defects (VSDs) 34.7% (43/124), Atrial septal defects (ASDs) 34.7% (43/124) and tetralogy of fallot (TOF) in 10.5% (13/124). Non governmental organizations (NGOs) funded 96.8% (120/124) of the operations, and in only 4 patients (3.2%) families paid for the surgeries. There was increasing complexity in cases operated upon from predominantly ASDs and VSDs at the beginning to more complex cases like TOFs and TAPVR. The local team independently operated 19 patients (15.3%). Postoperative morbidity was low with arrhythmias, left ventricular dysfunction and re-operations being the commonest seen. Post operative sepsis occurred in only 2 cases (1.6%). The overall mortality rate was 3.2 %Conclusion: Open heart surgery though expensive is feasible in a developing country. With increased direct funding from governments and local charities to support open heart surgeries, more cardiac patients access surgical treatment locally.Keywords: Open heart surgery, Uganda Heart Institut

    The effect of hemofilter, preoperative and intraoperative methylprednisolone on complications after open heart surgery

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    Complications after open heart surgery may threaten patient’s survival rate. Theintraoperative methylprednisolone administration alone shows controversial resultson open heart surgery complications. Similarly, the intraoperative and preoperativemethylprednisolone administration as well as the use of hemofilter in open heart surgeryis still controversial. This study aimed to evaluate the effect of hemofilter, preoperativeand intraoperative methylprednisolone administration on complications following openheart surgery. This was a Prospective Randomized Open-Blinded Evaluation (PROBE)experimental study. Ninety-five patients who had open heart surgery in Dr. SardjitoGeneral Hospital, Yogyakarta, and Integrated Cardiac Care of Dr. Cipto MangunkusumoGeneral Hospital, Jakarta within the period of December 2011 to May 2012 wereinvolved in this study. The patients were divided into two groups i.e. group A, 48 patientsreceived methylprednisolone 15mg/kg intraoperatively, methylprednisolone 5mg/kgpreoperatively, and hemofilter, while group B, 47 patients received methylprednisolone15mg/kg intraoperatively alone. From the total 95 patients, we found 26 (27.4%)patients experienced complications i.e. 19 in group B (40.4%) and 7 in group A(14.6%). The differences of the complications were statistically significant (p<0.05;OR=3.97; 95%CI=1.476-10.71). Complications risk decreased by 63.9% in the groupA compared to the group B with the hazard ratio of 3.2. In conclusion, the application ofhemofilter, preoperative and intraoperative methylprednisolone might decrease the risk ofcomplications after open heart surgery

    Interdisciplinary three-step strategy to treat aortic stenosis and coronary artery disease in a patient with end-stage chronic obstructive pulmonary disease

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    Background: Valvular aortic stenosis is a common disease in the elderly, often in multimorbid patients. It is often associated with coronary artery disease and peripheral artery disease. In this situation, the risk of conventional open-heart surgery is too high, and other treatment strategies have to be evaluated. Case report: A 79-year-old female patient with severe aortic stenosis, coronary artery disease and end-stage chronic obstructive pulmonary disease suffering from dyspnea at rest and permanently dependent on oxygen was treated in three steps. Firstly, her pulmonary infection was treated with antibiotics for 7 days. Then, the left anterior descending artery was stented (bare-metal stent). In the same session, valvuloplasty of the aortic valve was performed. She was sent to rehabilitation to improve her pulmonary condition and took clopidogrel for 4 weeks. Finally, she underwent transapical aortic valve replacement. She was released to rehabilitation on postoperative day 12. Conclusion: A combination of modern interventional and minimally invasive surgical techniques to treat aortic stenosis and coronary heart disease can be a viable option for multimorbid patients with extremely high risk in conventional open-heart surgery

    Coronary artery fistulae : 4 cases repaired surgically

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    Coronary artery fistulae involve a communication between a coronary artery and a heart chamber or part of the pulmonary circulation. Most are asymptomatic and discovered incidentally, whilst larger ones may cause coronary steal syndrome. Fistulae may produce continuous murmurs and are diagnosed at echocardiography or angiography. Treatment is by percutaneous coil embolisation or open surgery. This article reviews four cases treated with surgical closure. All patients were asymptomatic and diagnosed incidentally at angiography. One case involved a failed attempt at percutaneous coil embolization requiring immediate open surgery. The other three cases required other operative procedures and the fistulae were oversutured during the same procedure.peer-reviewe

    Pacemaker Inhibition During Cardioplegia in Open Heart Surgery

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    A 53-year-old patient underwent mitral valve replacement after implantation of permanent pacemaker. During cardioplegia in open heart surgery, we performed the inhibition of permanent pacemaker to obtain complete myocardial preservation and quiet heart, using stimulations of an external pulse generator. This procedure is considered available, when the patient who has had a permanent pacemaker undergoes open heart surgery more safely

    Open heart surgery under hypothermia

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