scholarly journals Endovascular Embolization of Intracranial Infectious Aneurysms in Patients Undergoing Open Heart Surgery Using n-Butyl Cyanoacrylate

2017 ◽  
Vol 6 (1-2) ◽  
pp. 82-89 ◽  
Author(s):  
Esteban Cheng-Ching ◽  
Seby John ◽  
Mark Bain ◽  
Gabor Toth ◽  
Thomas Masaryk ◽  
...  
Keyword(s):  
Cerebral Artery ◽  
Heart Surgery ◽  
Short Interval ◽  
Open Heart Surgery ◽  
Cleveland Clinic ◽  
Endovascular Embolization ◽  
Open Heart ◽  
Aneurysm Embolization ◽  
Increased Risk ◽  
Mycotic Aneurysms

Introduction: Mycotic aneurysms are a serious complication of infective endocarditis with increased risk of intracranial hemorrhage. Patients undergoing open heart surgery for valve repair or replacement are exposed to anticoagulants, increasing the risk of aneurysm bleeding. These patients may require endovascular or surgical aneurysm treatment prior to heart surgery, but data on this approach are scarce. Methods: Retrospective review of consecutive patients with infectious endocarditis and mycotic aneurysms treated endovascularly with Trufill n-butyl cyanoacrylate (n-BCA) at the Cleveland Clinic between January 2013 and December 2015. Results: Nine patients underwent endovascular treatment of mycotic aneurysms with n-BCA (mean age of 39 years). On imaging, 4 patients had intracerebral hemorrhage, 2 had multiple embolic infarcts, and the rest had no imaging findings. Twelve mycotic aneurysms were detected (3 patients with 2 aneurysms). Seven aneurysms were in the M4 middle cerebral artery segment, 4 in the posterior cerebral artery distribution, and 1 in the callosomarginal branch. n-BCA was diluted in ethiodized oil (1:1 to 1:2). Embolization was achieved in a single rapid injection with immediate microcatheter removal. Complete aneurysm exclusion was achieved in all cases without complications. All patients underwent open heart surgery and endovascular embolization within a short interval, 2 with both procedures on the same day. There were no new hemorrhages after aneurysm embolization. Conclusions: Endovascular embolization of infectious intracranial aneurysms with liquid embolics can be performed successfully in critically ill patients requiring immediate open heart surgery and anticoagulation. Early embolization prior to and within a short interval from open heart surgery is feasible.

Low Incidence of Thrombosis in Hemophilic Patients Undergoing Surgeries or Invasive Procedures,

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4221-4221
Author(s):  
Yan Feng ◽  
Desiree Carcioppolo ◽  
Alan E. Lichtin
Keyword(s):  
Baseline Level ◽  
Heart Surgery ◽  
Trough Level ◽  
Open Heart Surgery ◽  
Cleveland Clinic ◽  
Factor Ix ◽  
Open Heart ◽  
Dvt Prophylaxis ◽  
History Of ◽  
Prophylactic Anticoagulation

Abstract Abstract 4221 BACKGROUND AND OBJECTIVE: The major concern for hemophilic patients who undergo surgery is bleeding, and they usually receive factor replacement. Since surgery is a well known risk factor for venous thrombosis, non-hemophilic patients frequently receive DVT prophylaxis in post-op period. However the risk of venous thrombosis in hemophilic patients who undergo surgery is rarely studied or reported. We observed a patient with severe hemophilia B who developed extensive DVT after open heart surgery when he was receiving factor IX replacement. This prompted a retrospective chart review study to evaluate the risk of DVT in hemophilia patients who undergo surgery or invasive procedure. SUBJECTS AND METHOD: A total of 154 patients who received factor VIII or IX replacement from Feb. 1997 to June 2011 at Cleveland Clinic were identified by searching the pharmacy database. A total of 38 patients who underwent 58 elective surgeries were finally included in the analysis. Patients who had surgery for bleeding were excluded RESULTS: All patients are male, except one female hemophilic carrier. Patients' age at surgery varied from 9 months to 85 years with median age 48 years. Twenty seven patients (71%) had factor VIII deficiency with baseline level 1%-31% (median 5%, 25th to 75th 2%-12%). Eleven patients (29%) had factor IX deficiency with baseline level 2%-36% (median 5%, 25th to 75th 3%-8%). Thirteen patients had more than one surgery at Cleveland Clinic. Out of these 58 surgeries/procedures in these 38 patients, 15 were orthopedic, 10 open heart, 10 abdominal (including liver and kidney transplant), 5 neurosurgery, 2 head and neck and 16 other surgery (including 3 vascular procedures). The factor replacement duration was 1–19 days (median 8 days, 25th to 75th5 to 9 days). The median trough level was 97% (25th to 75th77% to 130%). Eighteen (31%) patients had post-op bleeding defined as requiring surgical intervention or more than 1 unit blood transfusion. One patient received subcutaneous heparin for DVT prophylaxis from day 2 after his head/neck surgery and did not experience any episodes of bleeding or DVT. Six patients (5 with open heart surgery and one with carotid endarterectomy) received aspirin post-operatively (one with clopidogrel and one with warfarin on discharge) and two of them experienced bleeding (both had mild thrombocytopenia and one had trough factor IX level 55%). One patient had one episode of TIA on the next day after total knee replacement (his trough level was 98%). Only one patient had DVT after surgery. He was a 72 year old male with hemophilia B (factor IX baseline level 5%) who underwent an open heart surgery (1 vessel CABG, mitral valve repair and pulmonary vein isolation). He did have history of renal thrombosis when he was on factor IX concentrate replacement twenty years ago. He was started with recombinant factor IX twice daily before his open heart surgery, and dose adjusted based on trough level, which was maintained near 100%. On post-op day 5, he developed an occlusive DVT extending from the right internal jugular vein to median cubital vein, where he had a temporary central line placed post-op. He was ambulatory but not on aspirin or DVT prophylaxis. He was anticoagulated with heparin which was subsequently converted to warfarin, along with factor IX infusion. He did well and was discharged home on post-op day 14. CONCLUSION: We found two thrombotic events (DVT and TIA) in this retrospective study (3.4%). Had routine prophylactic anticoagulation been given to all patients, a higher incidence of bleeding could be anticipated. This study therefore supports the position of not giving routine prophylactic anticoagulation to hemophilic patients undergoing surgery, unless there is previous history of excessive thrombosis with factor replacement. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Cardiac Troponin T for Prediction of Short- and Long-Term Morbidity and Mortality after Elective Open Heart Surgery

2004 ◽  
Vol 50 (9) ◽  
pp. 1560-1567 ◽  
Author(s):  
Stephanie Lehrke ◽  
Henning Steen ◽  
Hans H Sievers ◽  
Hanno Peters ◽  
Armin Opitz ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Cell Injury ◽  
Troponin T ◽  
Open Heart Surgery ◽  
Cleveland Clinic ◽  
Myocardial Cell ◽  
Risk Indicators ◽  
Open Heart ◽  
Cardiac Mortality

Abstract Background: Increased cardiac troponins in blood are observed after virtually every open heart surgery, indicating perioperative myocardial cell injury. We sought to determine the optimum time point for blood sampling and the respective cutoff value of cardiac troponin T (cTnT) for risk assessment in patients undergoing cardiac surgery. Methods: In a series of 204 patients undergoing scheduled open heart surgery, mainly for coronary artery bypass grafting (n = 132) or valve repair (n = 27), cTnT concentrations were measured before and 4 and 8 h after cross-clamping and then daily for 7 days. Individual risk was assessed by use of the Cleveland Clinic Foundation Risk score and intraoperative risk indicators such as duration of cardiopulmonary bypass, cross-clamping, and perioperative release of cardiac markers. Patients were followed for 28 months. Results: Cardiac mortality, all-cause mortality rates, and rates of nonfatal acute myocardial infarction (AMI) at 28 months were 6.9%, 8.8%, and 6.8%, respectively. cTnT was higher in patients with Q-wave AMI or postoperative heart failure requiring inotropic support, and in nonsurvivors. The ROC curve revealed a cTnT ≥0.46 μg/L at 48 h as the optimum discriminator for long-term cardiac mortality. Stepwise logistic regression identified higher Cleveland Clinic Risk Score [odds ratio (OR) = 2.6 per point], cross-clamp time >65 min (OR = 6.6), and cTnT (OR = 4.9) as significant and independent predictors of long-term cardiac mortality. Conclusions: A single postoperative cTnT measurement can be used to estimate myocardial cell injury that impacts long-term survival after open heart surgery. It adds independently to established risk indicators.

Postoperative administration of tranexamic acid as approach to reduce blood loss after open-heart surgery

2020 ◽  
Vol 76 (1) ◽  
pp. 43-49
Author(s):  
Florian Meissner ◽  
Katrin Plötze ◽  
Klaus Matschke ◽  
Thomas Waldow
Keyword(s):  
Blood Loss ◽  
Tranexamic Acid ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Postoperative Blood Loss ◽  
Open Heart ◽  
Reduce Blood Loss ◽  
Perioperative Bleeding ◽  
Increased Risk ◽  
Postoperative Administration

BACKGROUND: Tranexamic acid (TXA) reduces perioperative bleeding among patients undergoing heart surgery. It is uncertain whether its postoperative administration, after prior administration before cardiopulmonary bypass (CPB), has an additional benefit. OBJECTIVE: Our study aimed to evaluate whether the postoperative administration of TXA reduces the blood loss after heart surgery. METHODS: In a retrospective cohort study at the University Heart Center Dresden, patients who underwent on-pump open-heart surgery and received 1 g TXA before CPB were included. Patients with postoperative administration of 1 g TXA were compared to patients without. Primary endpoint was the postoperative blood loss within 24 hours. RESULTS: Among 2,179 patients undergoing heart surgery between 1 July 2013 and 31 October 2014, 92 (4.2%) received TXA postoperatively. After matching, 71 patients with postoperative administration of TXA were compared to 71 without (n = 142). Postoperative administration of TXA did not result in decreased blood loss (MD 146.7 mL; p = 0.064). There was no evidence of an increased risk for thromboembolic complications. CONCLUSIONS: The postoperative administration of TXA did not reduce blood loss. The use of TXA was shown to be safe in terms of thromboembolic events and hospital mortality. Unless there is no clear evidence, the postoperative administration of TXA should be restricted to patients with massive blood loss and signs of hyperfibrinolysis only.

Elevated Preoperative Fasting Serum Glucose Levels Increase the Risk of Postoperative Mediastinitis in Patients Undergoing Open Heart Surgery

2003 ◽  
Vol 24 (10) ◽  
pp. 776-778 ◽  
Author(s):  
Stephen J. Wilson ◽  
Daniel J. Sexton
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Serum Glucose ◽  
Open Heart ◽  
Preoperative Fasting ◽  
Fasting Serum ◽  
Fasting Serum Glucose ◽  
Glucose Levels ◽  
Increased Risk ◽  
The Relationship

AbstractWe conducted a case-control study to investigate the relationship between preoperative fasting serum glucose and postoperative mediastinitis in patients undergoing open heart surgery. Multivariate analysis revealed that a glucose level of 126 mg/dL or greater was associated with a significantly increased risk of mediastinitis (OR, 5.25; P = .002).

scholarly journals Dexmedetomidine-Associated Hyperthermia: A Retrospective Cohort Study of Intensive Care Unit Admissions between 2009 and 2016

2017 ◽  
Vol 45 (6) ◽  
pp. 727-736 ◽  
Author(s):  
K. E. D. Grayson ◽  
A. E. Tobin ◽  
D. T. K. Lim ◽  
D. E. Reid ◽  
M. Ghani
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Increased Risk

Dexmedetomidine-associated hyperthermia has not been previously studied. Analysis is warranted to determine whether this potentially dangerous complication is more prevalent than previously realised. We aimed to examine the association between dexmedetomidine and temperature ≥39.5°C, including patient characteristics, temporality and potential risk factors. We conducted a retrospective cohort study of all intensive care unit (ICU) admissions between 1 July 2009 and 31 May 2016 in a tertiary ICU in Australia. Temperature data was available for 9,782 ICU admissions. Dexmedetomidine was given intravenously to 611 (6.3%) patients at a dose of 0 to 1.5 g/kg/hour. Temperatures ≥39.5°C were recorded in 341 (3.5%) patients. Overall hospital mortality was 10.8% for all admissions and 29.3% for patients with temperatures ≥39.5°C. Dexmedetomidine exposure was more frequent in patients with temperature recordings ≥39.5°C compared to those with temperatures <39.5°C, 11.94% versus 2.94% (odds ratio [OR] 4.49; 95% confidence intervals [CI] 3.37, 5.92; P <0.001). The association was stronger for patients post-open heart surgery (OHS) with temperatures ≥39.5°C (OR 12.9; 95% CI 5.01, 31.62; P <0.001). Multivariate analysis showed an independent association between dexmedetomidine and a temperature ≥39.5°C in two particular patient groups: OHS (OR 2.72; 95% CI 1.1, 6.9; P <0.001), and obesity (OR 3.44; 95% CI 1.5, 7.9; P <0.001). Dexmedetomidine exposure is associated with an increased risk of hyperthermia. Possible risk factors are open heart surgery and obesity.

Children with genetic disorders undergoing open-heart surgery: Are they at increased risk for postoperative complications?*

2011 ◽  
Vol 12 (5) ◽  
pp. 539-544 ◽  
Author(s):  
Carsten Doell ◽  
Vera Bernet ◽  
Luciano Molinari ◽  
Ingrid Beck ◽  
Christian Balmer ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Heart Surgery ◽  
Genetic Disorders ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Increased Risk

Increased Risk of Transmission of Hepatitis C in Open Heart Surgery Compared With Vascular and Pulmonary Surgery

2010 ◽  
Vol 90 (5) ◽  
pp. 1425-1431 ◽  
Author(s):  
Karina Olsen ◽  
Per Erling Dahl ◽  
Eyvind J. Paulssen ◽  
Anne Husebekk ◽  
Anders Widell ◽  
...  
Keyword(s):  
Hepatitis C ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Pulmonary Surgery ◽  
Increased Risk
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