Annals of Cardiac Anaesthesia最新文献

Objective: The primary objective is to identify how often do adult patients, who undergo elective open-heart surgeries are fast track extubated. Secondary objectives are to identify the causes of delayed extubation and to quantify the frequency of re-intubation and hospital stay in fast-track patients.

Study design: Retrospective cross-sectional study.

Place and duration of the study: The Cardiovascular Intensive Care Unit (CICU) at Department of Anesthesia, Aga Khan University Hospital, Karachi, Pakistan, where data was collected from January 2021 to December 2022.

Methodology: Data of 419 adult patients admitted to the CICU and who underwent elective open-heart surgery, during the study period were included. Demographic and clinical information of the patients was collected using proforma eliciting details keeping anonymity and confidentiality of patients. Statistical analysis was conducted by RStudio (version 4.1.2, Boston, USA).

Results: There were 58.4% (n = 245) of 419 patients extubated within the FastTrack window. No significant differences were seen in demographic and clinical characteristics (except surgery type, P < 0.001). There was significant difference in intraoperative outcomes (CICU arrival time, temperature, Vasoactive-Inotropic Score [VIS], and hospital stay) between groups (P < 0.001). High inotropic support, late night cases, bleeding and hypothermia were the major causes of delayed extubation.

Conclusion: In patients undergoing elective open heart surgeries including elective CABG, fast track extubation is a feasible, safe, and effective option in improving resource utilization and patient outcome. Early extubation and prevention of postoperative complication can be facilitated by optimizing perioperative care protocols. Fast-track protocols should be standardized to protect patient safety. Fast track extubation requires careful patient selection and individual patient characteristics need to be considered.

Abstract: This study describes the perioperative management of a 68-year-old Jehovah's Witness patient with chronic pulmonary thromboembolism, multiple comorbidities, and undergoing pulmonary thromboendarterectomy. The patient had a satisfactory perioperative evolution, demonstrating the feasibility of this complex procedure in this population with a comprehensive and timely approach, complemented by an evaluation from a multidisciplinary team.

Background: Major adverse cardiac events (MACE) are the leading cause of morbidity and mortality during carotid endarterectomy (CEA). The primary outcome of the study was to assess the incidence of perioperative MACE and non-MACE in patients with coronary artery disease (CAD) undergoing CEA. The secondary objectives were to analyze the incidence of MACE and non-MACE based on various perioperative risk factors.

Methods: This retrospective study included patients with CAD who underwent CEA for carotid artery disease from July 2013 to June 2023. We analyzed the incidence of perioperative MACE and non-MACE and its association with revised cardiac risk index (RCRI) score, previous coronary revascularization, beta-blocker therapy, previous myocardial infarction (MI), the time interval from stroke to CEA, and multivessel CAD.

Results: Medical records of 101 patients were studied. The incidence rates of perioperative MACE and non-MACE were around 18.8% and 15.8%, respectively. A preoperative coronary revascularized patient to develop patient's odds of developing a MACE (OR: 0.184, CI: 0.0398-0.8497) and non-MACE (OR: 0.051, CI: 0.0132-8.331) were lower than a non-revascularized patient. There were no significant differences in the incidence of perioperative MACE and non-MACE concerning RCRI score, beta-blocker therapy, previous MI, varying time intervals from stroke to surgery, and severity of CAD.

Conclusion: There was a higher incidence of perioperative MACE and non-MACE in patients with CAD undergoing CEA. Preoperative coronary revascularization reduced the incidence of perioperative cardiovascular events in these subsets of patients.

Abstract: The Doppler-derived gradient depends on the magnitude of the flow across a narrowed orifice and the alignment of the Doppler with the flow. Septal myectomy is indicated in symptomatic obstructive hypertrophic cardiomyopathy (HCM) patients with peak instantaneous gradient > 50 mmHg. Chordal rupture has been reported infrequently in obstructive HCM patients, which may hide left ventricular outflow tract (LVOT) gradient because of a decreased forward flow across the LVOT, posterior shift of the coaptation point due to flail posterior mitral leaflet widening the LVOT, or absence of systolic anterior motion (SAM). An increase in the flow across the LVOT will occur after mitral valve repair, which may manifest as an increased LVOT gradient. In a clinical scenario of the simultaneous presence of severe mitral regurgitation, severe septal hypertrophy, and low gradient across the LVOT, the dilemma is whether to perform a septal myectomy in addition to MV repair. An unexpected increase in the LVOT gradient occurred despite septal myectomy in a patient with mitral regurgitation after mitral valve repair. We discuss the necessity of septal myectomy in the presence of a low LVOT gradient, severe mitral regurgitation, and posterior shift of the coaptation point due to posterior leaflet flail and chordal rupture.