scholarly journals Modulation of post-operative insulin resistance by pre-operative carbohydrate loading

2002 ◽  
Vol 61 (3) ◽  
pp. 329-336 ◽  
Author(s):  
Olle Ljungqvist ◽  
Jonas Nygren ◽  
Anders Thorell
Keyword(s):  
Insulin Resistance ◽  
Heart Surgery ◽  
Surgical Stress ◽  
Elective Surgery ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Length Of Hospital Stay ◽  
Cardiac Complications ◽  
Intravenous Glucose ◽  
Mortality And Morbidity

Insulin resistance develops as a response to virtually all types of surgical stress. There is an increasing body of evidence that suggests that insulin resistance in surgical stress is not beneficial for outcome. A recent large study in intensive-care patients showed that aggressive treatment of insulin resistance using intravenous insulin reduced mortality and morbidity substantially. Similarly, in burn patients, intensive insulin and glucose treatment has been shown to improve N economy and enhance skin-graft healing. In surgical patients insulin resistance has been characterized in some detail, and has been shown to have many similarities with metabolic changes seen in patients with type 2 diabetes. This finding may be important since insulin resistance has been shown to be one independent factor that influences length of stay. When patients about to undergo elective surgery have been treated with glucose intravenously or a carbohydrate-rich drink instead of overnight fasting, insulin resistance was reduced by about half. A small meta-analysis showed that when post-operative insulin resistance was reduced by preoperative carbohydrates, length of hospital stay was shortened. Overnight intravenous glucose at high doses improved post-operative N economy. This type of treatment has also been shown repeatedly to reduce cardiac complications after open-heart surgery. Furthermore, if the carbohydrates are given as a drink pre-operatively, pre-operative thirst, hunger and anxiety are markedly reduced. In summary, preventing or treating insulin resistance in surgical stress influences outcome. Fasting overnight is not an optimal way to prepare patients for elective surgery. Instead, pre-operative carbohydrates have clinical benefits.

scholarly journals Endovascular treatment for intracranial infectious aneurysms

2008 ◽  
Vol 66 (4) ◽  
pp. 790-794 ◽  
Author(s):  
Eduardo Wajnberg ◽  
Fernanda Rueda ◽  
Edson Marchiori ◽  
Emerson L. Gasparetto
Keyword(s):  
Endovascular Treatment ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Intracranial Bleeding ◽  
Infectious Endocarditis ◽  
Cardiac Complications ◽  
Endovascular Techniques ◽  
Treatment Results ◽  
Mycotic Aneurysms ◽  
Favorable Clinical Outcome

OBJETIVE: To re-enforce an alternative, less aggressive treatment modality in the management of intracranial infectious aneurysms. METHOD: We present a series of five patients with infectious endocarditis and intracranial infectious aneurysms (mycotic aneurysms) managed by means of endovascular treatment. RESULTS: Endovascular treatment was executed technically uneventfully in all patients. Three patients had favorable clinical outcome: two were classified as Glasgow Outcome Scale 4/5, and one had total neurological recovery (GOS 5/5). Two patients died (GOS 1/5), one in consequence of the initial intracranial bleeding and the other after cardiac complications from endocarditis and open-heart surgery. CONCLUSION: Endovascular techniques are an expanding option for the treatment of IIAs. It has been especially useful for infectious endocarditis patients with IIA, who will be submitted to cardiac surgery with cardiopulmonary bypass and anticoagulation, with the risk of intracranial bleeding.

Ultrafiltration in Pediatric Cardiac Surgery Review

2019 ◽  
Vol 10 (6) ◽  
pp. 778-788 ◽  
Author(s):  
Joel Bierer ◽  
Roger Stanzel ◽  
Mark Henderson ◽  
Suvro Sett ◽  
David Horne
Keyword(s):  
Cardiac Surgery ◽  
Clinical Outcomes ◽  
Heart Surgery ◽  
Fluid Overload ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Pediatric Cardiac Surgery ◽  
Significant Heterogeneity ◽  
Study Protocols ◽  
The Impact

Introduction: The use of cardiopulmonary bypass in pediatric cardiac surgery is associated with significant inflammation, fluid overload, and end-organ dysfunction yielding morbidity and mortality. For decades, various intraoperative ultrafiltration techniques such as conventional ultrafiltration, modified ultrafiltration (MUF), zero-balance ultrafiltration (ZBUF), and combination techniques (ZBUF-MUF) have been used to mitigate these toxicities and promote improved postoperative outcomes. However, there is currently no consensus on the ultrafiltration technique or strategy that yields the most benefit for infants and children undergoing open heart surgery. Methods: A librarian-conducted PubMed literature search from 1990 to 2018 yielded 90 clinical studies or publications on the various forms of ultrafiltration and the impact on physiologic markers and clinical outcomes. All publications were reviewed, summarized, and conclusions synthesized. The data sets were not combined for systematic or meta-analysis due to significant heterogeneity in study protocols and patient populations. Results: Modified ultrafiltration significantly promotes improved myocardial function, reduction in fluid overload, and reduced bleeding and transfusion complications. Furthermore, ZBUF has shown a consistent reduction in inflammatory cytokines and improved pulmonary function and compliance. There is conflicting evidence that MUF, ZBUF, and ZBUF-MUF culminate in reduced ventilation time and intensive care unit stay. Conclusion: Various modes of ultrafiltration have been shown to be associated with improved physiologic function or clinical outcomes in pediatric cardiac surgery. There are some inconsistent trial results that can be explained by heterogeneity in ultrafiltration, clinical staff preferences, and institution protocols. Ultrafiltration has some essential benefit as it is ubiquitously used at pediatric heart centers; however, the optimal protocol could be yet identified.

scholarly journals P399Colchicine for prevention of atrial fibrillation after open-heart surgery: a systematic review and meta-analysis

EP Europace ◽  
2018 ◽  
Vol 20 (suppl_1) ◽  
pp. i72-i72
Author(s):  
C Lennerz ◽  
M Barman ◽  
M Sopher ◽  
M Tantawy ◽  
C Kolb ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Heart Surgery ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Open Heart

Mediastinitis in open heart surgery: a systematic review and meta-analysis of risk factors

2019 ◽  
Vol 53 (5) ◽  
pp. 226-234
Author(s):  
Michael Abdelnoor ◽  
Irene Sandven ◽  
Øystein Vengen ◽  
Ivar Risnes
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Heart Surgery ◽  
Meta Analysis ◽  
Open Heart Surgery ◽  
Open Heart

scholarly journals A.13 Non-cardiac complications after open-heart surgery with cardiopulmonary bypass

1996 ◽  
Vol 76 ◽  
pp. 4
Author(s):  
S. Rodiño ◽  
M.J. Martin ◽  
S. Garrido ◽  
A. Toral ◽  
C. Fernández-Goti ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Cardiac Complications ◽  
Open Heart

scholarly journals Fast-track Cardiac Surgery in Children: Feasibility in Bangladeshi Setting

1970 ◽  
Vol 3 (1) ◽  
pp. 50-54 ◽  
Author(s):  
SA Quader ◽  
R Sarker ◽  
F Ahmed ◽  
MK Hasan ◽  
AK Beg ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hospital Stay ◽  
Fast Track ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Postoperative Mortality ◽  
Control Group ◽  
Mortality And Morbidity ◽  
Surgical Closure ◽  
Fast Tracking

Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner. Keywords: Cardiac surgery; Congenital heart disease; Fast track; Hospital discharge. DOI: 10.3329/cardio.v3i1.6427Cardiovasc. j. 2010; 3(1): 50-54

scholarly journals Open Cardiac Surgery without Blood and Blood Products Transplantation

2017 ◽  
Vol 20 (6) ◽  
pp. 239 ◽  
Author(s):  
Mehmet Kaplan ◽  
Tolga Can ◽  
Anil Karaagac ◽  
Murat Acarel ◽  
Adlan Olsun ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Urine Output ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Morbidity And Mortality ◽  
Open Heart ◽  
Blood Products ◽  
Mortality And Morbidity ◽  
Significant Difference

Background: Blood transfusions are the most common type of tissue and organ transplantation. Perioperative and postoperative transfusions may cause morbidity and mortality and transfusion should based on only hematocrit values but also on hemodynamic and clinical parameters of the patient, which cannot be ignored.Methods: A prospective study was conducted between January 2015 and October 2016 with adult patients undergoing elective open heart surgery. In these patients, a protocol was established, and patients were divided into two groups as transfusion (-) and transfusion (+). In the first 24 hours in the intensive care unit, patients’ drainage, 24-hours urine output, awakening and extubation times, and lactate and bilirubin levels in arterial blood gases were recorded. Thirty-day mortality and morbidity, and hemodynamic and clinical data were compared between these two groups.Results: We have performed a total of 138 cases; no blood and blood products were transfused in 71% (n = 98), and in 29.0% (n = 40) blood and blood products were transfused. Thirty-day mortality and morbidity (arrhythmia, infectious and pulmonary morbidity, myocardial infarction, cerebrovascular accident, renal dysfunction, sternal revision) were compared between these two groups and no statistically significant difference was observed. Patients’ awakening, extubation time, cardiopulmonary bypass period, cross-clamp time, and days in intensive care unit and hospital were compared, and there was no statistically significant difference between the two groups. Conclusion: In this study, we conclude that open heart surgery without blood transfusion may be accomplished with decent peri/postoperative management. The patients who did not receive any blood or blood products were not compromised clinically or hemodynamically. No extra morbidity and mortality were seen in the non-transfusion group. Transfusion decision was based on clinical and hemodynamic parameters such as persistent hypotension or tachycardia, hyperlactatemia, low urine output, and anemic symptoms. 

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