Browsing by Subject "Cardiac Surgical Procedures"
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Item Appropriateness of Preoperative Antimicrobial Therapy Does not Impact Outcomes Following Surgery for Infective Endocarditis(2017-03-29) Squiers, John Jay; DiMaio, J. Michael; Le, Binh-Minh (Jade); McGuire, Darren K.BACKGROUND: A long-standing paradigm of the surgical management of infective endocarditis was to delay surgery until the infection was adequately treated out of concern for increased technical difficulties due to acutely inflamed valvular tissue present during active infection. Up to half of patients with infective endocarditis may initially receive bacteriologically inadequate antimicrobial therapy, delaying time to surgery in these patients. However, several benefits of earlier surgery in certain patients with infective endocarditis and guideline-directed indication(s) for surgery have emerged over the last decade. Thus, surgeons are increasingly faced with a decision whether to operate on patients with infective endocarditis whose infection may not be adequately treated prior to surgery. OBJECTIVE: We sought to examine the characteristics of patients with infective endocarditis requiring surgical treatment and to determine whether the appropriateness of preoperative antimicrobial therapy impacted their short-term and long-term outcomes. METHODS: Records of 335 consecutive patients undergoing valve surgery to treat infective endocarditis between 1990-2013 at a single center were retrospectively reviewed. All patients with definite or possible infective endocarditis, defined by modified Duke criteria, and with positive blood cultures prior to surgery were included in the study. Two infectious disease clinicians, blinded to patient outcomes, graded appropriateness of preoperative antimicrobial regimens. RESULTS: A total of 270 patients (190 men; mean age 46.2 years) met inclusion criteria. Appropriate preoperative antimicrobial therapy was administered to 217 (80%) patients. Enterococci and fungal infections were more common in the inappropriately treated group, as was recurrent infective endocarditis. A history of viral hepatitis was less common in the inappropriately treated group. Otherwise, there were no significant differences in the rates of baseline comorbidities, valve involvement, or etiologic microorganisms among the groups. Operative mortality was 12.9% overall, with no significant difference between the appropriately (14%) and inappropriately (8%) treated groups (p=0.28). There was no difference in unadjusted, all-cause, five-year survival between the appropriately (48%) and inappropriately (52%) treated groups (log-rank p=0.30). CONCLUSION: There were no significant differences in short- and long-term mortality between patients receiving appropriate versus inappropriate preoperative antimicrobial therapy prior to valve surgery for infective endocarditis. Surgeons should not hesitate to operate on patients with infective endocarditis and a guideline-directed indication for valve surgery, even if their preoperative antimicrobial regimen has been inadequate.Item Evaluation of the patient after coronary bypass surgery(1980-10-23) Narahara, Kenneth A.Item [News](1979-11-06) Rutherford, SusanItem Pediatric Cardiac Surgery in Developing Countries of Africa: Current State and Future Direction(2014-04-11) Lee, Kyongjune Benjamin; Mihalic, Angela; Abdelnaby, Abier; Nwariaku, Fiemu; Jones, EugeneSurgical services are often the most neglected part of medical care in developing countries of Africa. Cardiac surgical care is even less accessible in comparison due to its need for highly skilled individuals and sophisticated equipment. This lack of proper care places the pediatric population affected by cardiac conditions without much hope for the future. Combining my clinical experience overseas with an extensive literature review, I examined the current state of pediatric cardiac surgery in several developing countries of Africa, and possible future efforts for establishing a viable cardiac surgery centers in low-resource settings. I examined in detail the two most prominent cardiac conditions in the developing world: congenital heart disease and rheumatic heart disease. The review of literature showed that cardiac surgical care is a serious need in many developing countries. It also revealed that with careful long-term international collaboration between institutions, a self-sustainable and economically viable cardiac surgical center with reasonable outcome can be established.Item Peritoneal Drainage after Surgical Intervention for Congenital Heart Disease(2015-01-26) Ritchie, Christine; Renkes, Rachel; Burkhalter, Lorrie; Pak, S. W.; Bliss, D. P.PURPOSE: Patients who undergo surgical intervention for congenital heart disease frequently develop abdominal ascites and elevated intraabdominal pressures. In this study, we review a single institution's experience with peritoneal drainage (PD) catheters in patients who have undergone surgical intervention for congenital heart disease. METHODS: We retrospectively reviewed medical records of all patients in whom PD catheters were placed after cardiac surgery for congenital heart disease over 5 years. RESULTS: Sixty-six patients received PD catheters after cardiac surgery. Twenty-seven (40.9%) were male. The mean age was 2.5 years (Range: 5 days - 23.3 years). Mean duration of therapy was 42.5 days (Range: 1-401 days). Thirty-seven (56.1%) patients received PD catheters within 30 days (Mean 11.2 days). Thirty-three (50%) patients survived. There were no differences in sex, age, duration of therapy, drain output, vasopressor requirement, or creatinine between survivors and nonsurvivors. CONCLUSION: While peritoneal drainage catheters may facilitate end organ perfusion and venous return, it is unclear whether they confer a survival advantage. In the setting of PD catheter placement, factors other than patient sex, age, and drain effectiveness, likely play a larger role in patient outcomes.Item The Role of Resilience in Cardiovascular Surgery Recovery(2020-08-01T05:00:00.000Z) Curcio, Nicholas Edmund; Warren, Ann Marie; Robinson, Richard C.; Edgerton, James; Bennett, Monica; Roaten, Kimberly DayleThe notion that a positive mindset is beneficial for one's health is widely accepted in today's culture. High levels of resilience have been linked to better physical and mental health outcomes within both general and chronic disease populations. To date, there has been little research conducted on the role resilience plays following cardiac surgery. In a sample of 402 cardiac surgery patients, we examined the associations of psychological resilience with other psychosocial constructs, healthcare utilization, and health related behavior in year following cardiac surgery. Resilience was significantly associated with both positive and negative psychosocial constructs at baseline and in the ensuing year. Such constructs included: spirituality, social support, quality of life, depression, and anxiety. In addition, patients with low resilience reported increased pain in the 30 days following surgery, as well as increased anxiety and depression in the following year. Resilience was not associated with any health related behavior change or healthcare utilization either in the 30 days or one year following surgery. Regression analyses revealed that spirituality was associated with an increase in resilience over the ensuing year, whereas having Black/African American race and never being married were associated with a decrease in resilience following surgery. These findings identify, for the first time, populations that are vulnerable to a decrease in resilience following cardiac surgery, as well as a potential avenue (i.e. spirituality) for bolstering resilience.Item Utility of Cardiac CT vs. MRI in Mitral Valve Architecture Evaluation(2018-04-04) Chauhan, Siddharth; Bajona, Pietro; Kay, Fernando; Vela, RyanINTRODUCTION: New minimally invasive and percutaneous techniques are being developed to repair and replace the mitral valve. These procedures rely upon the knowledge of the exact structure of the mitral valve and its surrounding structures. However, there has not been a standard method identified to accurately assess the mitral apparatus. METHODS: Perform an anatomic study to evaluate various structures associated with the mitral valve and mitral valve apparatus in 40 cadaveric hearts. The anatomic study will serve as baseline for comparison with a subsequent pilot imaging study, consisting of retrospective in vivo assessment of mitral valve and associated structures with cardiac computed tomography (CT) and magnetic resonance imaging (MRI) in four subjects. Main anatomic structures were qualitatively assessed on both imaging methods using a 5-point Likert scale. Imaging measurements were compared with anatomic study measurements. RESULTS: After analyzing the cardiac CT and cardiac MRI images, we found the cardiac CT was the only modality reliable to obtain measurements of the mitral valve apparatus. The cardiac MRI was unreliable in assessing the mitral valve apparatus and is supported by the quality assessment, which demonstrates that cardiac CT images are better to read for the mitral valve structures that were analyzed. CONCLUSION: Cardiac CT is the superior method in identifying the mitral valve apparatus in comparison to cardiac MRIs. The use of cardiac CTs may benefit physicians to formulate pre-op treatment plans but needs further research and development.