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Acute Kidney Injury After Acute Repair of Type A Aortic Dissection.

https://arctichealth.org/en/permalink/ahliterature311398
Source
Ann Thorac Surg. 2021 04; 111(4):1292-1298
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
04-2021
Author
Dadi Helgason
Solveig Helgadottir
Anders Ahlsson
Jarmo Gunn
Vibeke Hjortdal
Emma C Hansson
Anders Jeppsson
Ari Mennander
Shahab Nozohoor
Igor Zindovic
Christian Olsson
Stefan Orri Ragnarsson
Martin I Sigurdsson
Arnar Geirsson
Tomas Gudbjartsson
Author Affiliation
Internal Medicine Services, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland; Faculty of Medicine, University of Iceland, Reykjavik, Iceland. Electronic address: dadihelga@gmail.com.
Source
Ann Thorac Surg. 2021 04; 111(4):1292-1298
Date
04-2021
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Acute Kidney Injury - epidemiology - etiology - therapy
Aged
Aneurysm, Dissecting - surgery
Aortic Aneurysm, Thoracic - surgery
Female
Follow-Up Studies
Humans
Iceland - epidemiology
Incidence
Male
Middle Aged
Postoperative Complications - epidemiology - etiology
Registries
Renal Replacement Therapy - methods
Retrospective Studies
Time Factors
Vascular Surgical Procedures - adverse effects
Abstract
The aim of this study was to examine the incidence, risk factors, and outcomes of patients with acute kidney injury (AKI) after surgery for acute type A aortic dissection (ATAAD) using the Nordic Consortium for Acute Type A Aortic Dissection registry.
Patients who underwent ATAAD surgery at 8 Nordic centers from 2005 to 2014 were analyzed for AKI according to the RIFLE criteria. Patients who died intraoperatively, those who had missing baseline or postoperative serum creatinine, and patients on preoperative renal replacement therapy were excluded.
AKI occurred in 382 of 941 patients (40.6%), and postoperative dialysis was required for 105 patients (11.0%). Renal malperfusion was present preoperatively in 42 patients (5.1%), of whom 69.0% developed postoperative AKI. In multivariable analysis patient-related predictors of AKI included age (per 10 years; odds ratio [OR], 1.30; 95% confidence interval [CI], 1.15-1.48), body mass index >30 kg/m2 (OR, 2.16; 95% CI, 1.51-3.09), renal malperfusion (OR, 4.39; 95% CI, 2.23-9.07), and other malperfusion (OR, 2.10; 95% CI, 1.55-2.86). Perioperative predictors were cardiopulmonary bypass time (per 10 minutes; OR, 1.04; 95% CI, 1.02-1.07) and red blood cell transfusion (OR per transfused unit, 1.08; 95% CI, 1.06-1.10). Rates of 30-day mortality were 17.0% in the AKI group compared with 6.6% in the non-AKI group (P
PubMed ID
32961133 View in PubMed
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Acute type A aortic dissection--diagnostic aspects and surgical experience.

https://arctichealth.org/en/permalink/ahliterature54947
Source
Scand J Thorac Cardiovasc Surg. 1994;28(2):61-6
Publication Type
Article
Date
1994
Author
R. Pokela
T. Juvonen
J. Satta
P. Kärkölä
Author Affiliation
Department of Surgery, Oulu University Hospital, Finland.
Source
Scand J Thorac Cardiovasc Surg. 1994;28(2):61-6
Date
1994
Language
English
Publication Type
Article
Keywords
Acute Disease
Adult
Aged
Anastomosis, Surgical - adverse effects
Aneurysm, Dissecting - diagnosis - surgery
Angiography, Digital Subtraction
Aortic Aneurysm - diagnosis - surgery
Aortic Aneurysm, Thoracic - surgery
Blood Vessel Prosthesis
Cardiac Tamponade - ultrasonography
Echocardiography, Transesophageal
Female
Follow-Up Studies
Humans
Male
Middle Aged
Postoperative Complications
Reoperation
Survival Rate
Tomography, X-Ray Computed
Treatment Outcome
Abstract
Acute type A aortic dissection was surgically treated in 33 patients aged 20-65 years, all critically ill on admission to hospital. Transthoracic echocardiography revealed pericardiac tamponade in eight cases of extreme emergency, indicating surgery without need of additional imaging. Transesophageal echocardiography provided a definitive diagnosis in 16 cases, with excellent reliability and no false positive findings. Composite graft replacement with button technique was used in 24 patients and other methods of repair in nine. The perioperative mortality was 12% (4/33) and the late mortality 7% (2/29). The actuarial 5-year survival rate was 73%. No aortic root reoperation was required during follow-up for a mean of 4 years. Transesophageal echocardiography proved to be an accurate tool for speedy diagnosis of acute type A aortic dissection and open composite graft replacement with button technique highly satisfactory treatment, avoiding late aortic root problems.
PubMed ID
7863287 View in PubMed
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Application of the Parsonnet scoring system for a Canadian cardiac surgery program.

https://arctichealth.org/en/permalink/ahliterature160465
Source
Can J Cardiol. 2007 Nov;23(13):1061-5
Publication Type
Article
Date
Nov-2007
Author
Benoit de Varennes
Kevin Lachapelle
Renzo Cecere
Patrick Ergina
Dominique Shum-Tim
Christo Tchervenkov
John Sampalis
Author Affiliation
McGill University Health Centre, Division of Cardiac Surgery, Montreal, Quebec. benoit.devarennes@muhc.mcgill.ca
Source
Can J Cardiol. 2007 Nov;23(13):1061-5
Date
Nov-2007
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Canada - epidemiology
Cardiac Care Facilities
Cardiac Surgical Procedures - mortality
Comorbidity
Female
Hospitals, University
Humans
Male
Middle Aged
Outcome Assessment (Health Care) - methods
Program Development
Prospective Studies
Risk Assessment - methods
Risk factors
Survival Analysis
Thoracic Surgery
Abstract
In the past two decades, cases involving patients requiring cardiac surgery have become more complex, presenting with more comorbidities. Outcome analysis has become very important in assessing the quality of cardiac surgical care in these patients. The latest version of the Parsonnet scoring system was developed in 2000 and is the most recent system available.
To evaluate the accuracy of the Parsonnet scoring system in a major Canadian university-based cardiac surgery centre with a population of high-risk patients.
Data on 4883 consecutive patients operated on between 2000 and 2005 were prospectively collected, and a standardized mortality rate was calculated using the Parsonnet score as the ratio of observed deaths to expected deaths. Analyses were conducted on the whole group and on subgroups, based on Parsonnet score distribution quantiles, age and surgery status.
The mean Parsonnet score was 18.8+/-13.7 (range 0 to 83). The overall mortality rate was 6.4%. The overall standardized mortality ratio was 0.52 (95% CI 0.420 to 0.568), which was statistically significant (P=0.01). The observed mortality rate was significantly lower than expected in all categories.
Despite more complex cases with multiple comorbidities, the results of cardiac surgery in a Canadian university hospital show better results than expected when using the Parsonnet score.
Notes
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PubMed ID
17985008 View in PubMed
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Assessing the status of thoracic surgical research and quality improvement programs: a survey of the members of the Canadian Association of Thoracic Surgeons.

https://arctichealth.org/en/permalink/ahliterature133410
Source
J Surg Educ. 2011 Jul-Aug;68(4):258-65
Publication Type
Article
Author
Jelena Ivanovic
Donna E Maziak
Sebastien Gilbert
Farid M Shamji
R Sudhir Sundaresan
Tim Ramsay
Andrew J E Seely
Author Affiliation
Clinical Epidemiology Program, Ottawa Hospital Research Institute, University of Ottawa, Ottawa Hospital, Ottawa, Canada.
Source
J Surg Educ. 2011 Jul-Aug;68(4):258-65
Language
English
Publication Type
Article
Keywords
Canada
Databases, Factual
Female
Health Care Surveys
Humans
Male
Needs Assessment
Pilot Projects
Professional Practice - standards
Program Evaluation
Quality Assurance, Health Care
Quality Improvement - organization & administration
Questionnaires
Research - standards - trends
Societies, Medical
Thoracic Surgery - standards - trends
Abstract
Assessing the degree of involvement and participation in thoracic surgical research as well as surgical quality improvement conducted across Canadian institutions is difficult as no common data collection system and no prior studies exist. As a pilot investigation, we designed and conducted a membership survey of the Canadian Association of Thoracic Surgeons (CATS) to evaluate the extent of participation in research and quality improvement processes among thoracic surgeons.
A 45-item needs assessment survey was mailed to all national members of CATS (n = 86) in August 2009. Questions primarily focused on clinical research programs and research activity, research funding, database use and interest, and other methods of quality monitoring.
The 49 completed surveys represented a 57.0% response rate and 28 institutions across Canada. Research in basic and clinical science is conducted by 17.0% and 80.9% of the respondents, respectively. The annual budget of research funds is most commonly between $5000 and $50,000. A total of 72.0% (n = 18) of institutions do not have a formal surgery quality assessment program and 92.3% (n = 24) do not participate in a national or international thoracic surgery database. Ten institutions (38.6%) have a local thoracic surgery database for quality monitoring. Other systems of monitoring surgical quality include formal morbidity and mortality rounds (69.2%; n = 8 institutions), formal evaluation of surgical wait times (73.1%; n = 19 institutions), and patient satisfaction surveys (71.4%; n = 10 institutions). Overall, 97.8% of surgeons would be willing to share data on morbidity and mortality with other centers, and 73.1% have a high or very high level of interest in participating in a national thoracic surgery quality database.
A high level of interest and participation exists in thoracic surgery research. However, more robust quality improvement processes are needed for thoracic surgical oncology services. A national thoracic surgery quality improvement database offers a potential means to improve practice effectiveness, standardize surgical outcomes, and promote thoracic research across Canada.
PubMed ID
21708361 View in PubMed
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Assessment of vocal fold mobility before and after cardiothoracic surgery in children.

https://arctichealth.org/en/permalink/ahliterature133577
Source
Arch Otolaryngol Head Neck Surg. 2011 Jun;137(6):571-5
Publication Type
Article
Date
Jun-2011
Author
Luthiana F Carpes
Frederick K Kozak
Jacques G Leblanc
Andrew I Campbell
Derek G Human
Marcela Fandino
Jeffrey P Ludemann
J Paul Moxham
Humberto Fiori
Author Affiliation
Division of Pediatric Otolaryngology, BC Children's Hospital, Vancouver, Canada.
Source
Arch Otolaryngol Head Neck Surg. 2011 Jun;137(6):571-5
Date
Jun-2011
Language
English
Publication Type
Article
Keywords
Aorta, Thoracic - surgery
British Columbia
Cautery
Child, Preschool
Ductus Arteriosus, Patent - surgery
Female
Heart Arrest, Induced
Humans
Infant
Laryngoscopy
Male
Multivariate Analysis
Pulmonary Artery - surgery
Thoracic Surgical Procedures - adverse effects
Vocal Cord Paralysis - etiology
Abstract
To assess the incidence of vocal fold immobility (VFI) after cardiothoracic surgery in children and to determine the factors potentially associated with this outcome.
Flexible laryngoscopy to assess vocal fold mobility was performed before surgery and within 72 hours after extubation in 100 pediatric patients who underwent cardiothoracic procedures. The 2 operating surgeons recorded the surgical technique and their impression of possible injury to the recurrent laryngeal nerve. The presence of laryngeal symptoms, such as stridor, hoarseness, and strength of cry, after extubation was documented.
Of 100 children included in this study, 8 had VFI after surgery. Univariate analyses showed that these 8 patients were younger and weighed less than the patients with normal vocal fold movement. Monopolar cautery was used in all patients with VFI. On univariate analysis, factors statistically significantly associated with VFI were circulatory arrest and dissection or ligation of the patent ductus arteriosus, left pulmonary artery, right pulmonary artery, or descending aorta. However, multivariate analyses failed to show these associations.
The incidence of VFI after cardiothoracic surgery in our population of children was 8.0% (8 of 100). Of several factors found to be potentially associated with VFI on univariate analysis, none were significant on multivariate analysis. This may be a result of the few patients with VFI. A larger multicenter prospective study would be needed to definitively identify factors associated with the outcome of VFI.
PubMed ID
21690509 View in PubMed
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The association between nurse-administered midazolam following cardiac surgery and incident delirium: an observational study.

https://arctichealth.org/en/permalink/ahliterature124857
Source
Int J Nurs Stud. 2012 Sep;49(9):1064-73
Publication Type
Article
Date
Sep-2012
Author
Priscilla G Taipale
Pamela A Ratner
Paul M Galdas
Carol Jillings
Deborah Manning
Connie Fernandes
Jaime Gallaher
Author Affiliation
School of Nursing, The University of British Columbia, Vancouver, Canada. taipalep@interchange.ubc.ca
Source
Int J Nurs Stud. 2012 Sep;49(9):1064-73
Date
Sep-2012
Language
English
Publication Type
Article
Keywords
British Columbia
Delirium - chemically induced
Female
Humans
Hypnotics and Sedatives - administration & dosage - adverse effects
Male
Midazolam - administration & dosage - adverse effects
Nursing Staff
Tertiary Care Centers
Thoracic Surgery
Abstract
Post-operative delirium after cardiac surgery is an adverse event that affects patients' recovery and complicates the delivery of nursing care. Numerous risk factors for delirium are uncontrollable; however, nurses' pro re nata drug administration of sedatives may be a controllable risk factor.
This study examined the relationship between nurses' pro re nata administration of midazolam hydrochloride to cardiac surgery patients and the development of post-operative delirium.
Observational study.
Cardiac surgery intensive care and nursing units of a tertiary care center in Vancouver, Canada.
122 male and female patients requiring non-emergent surgery for coronary artery disease or valvular heart disease who did not have pre-existing cognitive impairment, severe hearing or visual impairment, substance misuse, alcohol intake exceeding 7 drinks per week, or renal impairment requiring hemodialysis.
Patients were assessed for delirium, on three occasions, with the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU) during the first 72 h after surgery and through reviews of physicians' notes. Risk factor and midazolam dosage data were collected from medical records.
77.9% of the patients in this sample received midazolam hydrochloride post-operatively. The prevalence of delirium ranged from 37.7% to 44.3%. Almost all of the dosages of midazolam (85-87%) were given before the first indication of delirium; that is, most of the patients had received their entire dosage before the first signs of delirium were detected. Bivariate analysis with logistic regression models revealed that for every additional milligram of midazolam administered, the patients were 7-8% more likely to develop delirium. Multivariate logistic regression models demonstrated that the magnitude of the association between midazolam dosage and delirium was not confounded by established risk factors including age and peripheral vascular disease.
Nurses play an important role in the prediction, assessment and prevention of post-operative delirium. Sedatives should be administered with caution because they increase a patient's risk of developing delirium. Nurses' decisions regarding sedation administration must be informed by empirical knowledge, accurate assessment data and clear rationale with consideration of how these actions may contribute to the development of delirium.
PubMed ID
22542266 View in PubMed
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Atrial Na,K-ATPase increase and potassium dysregulation accentuate the risk of postoperative atrial fibrillation.

https://arctichealth.org/en/permalink/ahliterature151950
Source
Cardiology. 2009;114(1):1-7
Publication Type
Article
Date
2009
Author
Cao Thach Tran
Thomas Andersen Schmidt
John Brochorst Christensen
Keld Kjeldsen
Author Affiliation
Laboratory for Molecular Cardiology, Medical Department B, The Heart Centre, Rigshospitalet, Juliane Maries Vej 20, Copenhagen DK-2100, Denmark. tran@dadlnet.dk
Source
Cardiology. 2009;114(1):1-7
Date
2009
Language
English
Publication Type
Article
Keywords
Aged
Atrial Fibrillation - enzymology - etiology - physiopathology
Denmark
Female
Heart Atria - enzymology
Homeostasis
Humans
Logistic Models
Male
Middle Aged
Myocardium - pathology
Ouabain - diagnostic use
Postoperative Complications - blood - enzymology - physiopathology
Potassium - blood
Sodium-Potassium-Exchanging ATPase - metabolism
Thoracic Surgery
Abstract
Postoperative atrial fibrillation is a common complication to cardiac surgery. Na,K-ATPase is of major importance for the resting membrane potential and action potential. The purpose of the present study was to evaluate the importance of Na,K-ATPase concentrations in human atrial biopsies and plasma potassium concentrations for the development of atrial fibrillation.
Atrial myocardial biopsies were obtained from 67 patients undergoing open chest cardiac surgery. Na,K-ATPase was quantified using vanadate-facilitated 3H-ouabain binding. Plasma potassium concentration was measured with ion-selective electrode.
In patients with preoperative sinus rhythm, 3H-ouabain-binding site concentration was 16% higher in patients developing postoperative atrial fibrillation compared to patients maintaining sinus rhythm [302 +/- 15 pmol/g wet weight (n = 20) vs. 261 +/- 11 mmol/g wet weight (n = 33), p = 0.03]. Also with multivariable analysis, 3H-ouabain-binding site concentration was significantly associated with the development of atrial fibrillation. High increase in plasma potassium concentration during the perioperative period and surgery was associated with postoperative atrial fibrillation.
The present study supports the increasing evidence of dysregulation of the potassium homeostasis as an important factor in the development of cardiac arrhythmias. High atrial Na,K-ATPase and sudden plasma potassium concentration increase may contribute to precipitate atrial fibrillation.
PubMed ID
19299895 View in PubMed
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The Canadian Society of Cardiac Surgeons perspective on the cardiac surgery workforce in Canada.

https://arctichealth.org/en/permalink/ahliterature121450
Source
Can J Cardiol. 2012 Sep-Oct;28(5):602-6
Publication Type
Article
Author
Christopher M Feindel
Maral Ouzounian
Timothy B Latham
Paul Hendry
Yves Langlois
Charles Peniston
Ansar Hassan
Roderick Macarthur
Hugh Scully
Gregory M Hirsch
Author Affiliation
Division of Cardiac Surgery, Peter Munk Cardiac Centre, Toronto, Ontario, Canada. Chris.Feindel@uhn.on.ca
Source
Can J Cardiol. 2012 Sep-Oct;28(5):602-6
Language
English
Publication Type
Article
Keywords
Adult
Aged
Canada
Cardiac Surgical Procedures - statistics & numerical data
Career Choice
Education, Medical, Graduate - methods
Female
Humans
Male
Middle Aged
Physicians - supply & distribution
Societies, Medical - organization & administration
Thoracic Surgery - manpower
Workload
Abstract
As the professional society representing cardiac surgeons in Canada, the Canadian Society of Cardiac Surgeons (CSCS) recognizes the importance of maintaining a stable cardiac surgical workforce. The current reactive approach to health human resource management in cardiac surgery is inadequate and may result in significant misalignment of cardiac surgeon supply and demand. The availability of forecasting models and high quality, consistent data on productivity, workload, utilization, and demand is a prerequisite for our profession's capacity to predict and plan for changes in health human resources. The CSCS recognizes that improved workforce management is a key component to providing optimal cardiac surgical care for Canadians in the future and has developed the recommendations in this document as a call to action to interested stakeholders and policymakers to bring substantial improvements to health human resource management in cardiac surgery.
PubMed ID
22906803 View in PubMed
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Canonical correlation analysis of risk factors and clinical outcomes in cardiac surgery.

https://arctichealth.org/en/permalink/ahliterature70556
Source
J Med Syst. 2005 Aug;29(4):357-77
Publication Type
Article
Date
Aug-2005
Author
Lisa Ridderstolpe
Hans Gill
Magnus Borga
Hans Rutberg
Hans Ahlfeldt
Author Affiliation
Department of Biomedical Engineering/Medical Informatics, Linköping University, S-581 85 Linköping, Sweden.
Source
J Med Syst. 2005 Aug;29(4):357-77
Date
Aug-2005
Language
English
Publication Type
Article
Keywords
Aged
Female
Humans
Intraoperative Care
Male
Middle Aged
Outcome Assessment (Health Care) - methods
Postoperative Care
Research Support, Non-U.S. Gov't
Retrospective Studies
Risk factors
Sweden
Thoracic Surgery
Abstract
Assessment of the association between risk factors and outcomes in cardiac surgery is a complex problem. The aim of this study was to explore the relationship between possible risk factors and several clinical outcomes in cardiac surgery by using canonical correlation analysis (CCA). This retrospective study of 2605 consecutive adult patients who underwent cardiac surgery, evaluated 74 potential risk factors and up to 12 outcomes by canonical correlation analysis. For three serious outcomes, sternal wound complications/mediastinitis, cerebral complications, and perioperative myocardial infarctions, CCA was preceded by univariate analyses and backward stepwise multivariate logistic regression analyses. The CCA suggests that the major risk factors for complications in these models are intraoperative and postoperative risk factors. The power of risk prediction models developed with multivariate regression analysis can be enhanced by application of canonical correlation analysis, thereby offering new ways of analyzing and interpreting sets of potential risk factors in relation to sets of clinical outcomes.
PubMed ID
16178334 View in PubMed
Less detail
Source
Eur J Cardiothorac Surg. 1998 Sep;14(3):223-8
Publication Type
Article
Date
Sep-1998

139 records – page 1 of 14.