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At least 37 records · Page 2Linked to original sources
PubMed2026

Nurse-led acute care post-operative interventions in adult cardiac surgery: a systematic review.

AIMS: The primary aim of this systematic review was to identify nurse-led clinical interventions evaluated in randomized controlled trials (RCTs) for adults who had undergone cardiac surgery. The secondary aim was to assess the effectiveness of these interventions on post-operative clinical and patient-reported outcomes during the acute inpatient phase. METHODS AND RESULTS: A systematic review was undertaken according to an a priori protocol using Joanna Briggs Institute (JBI) methodology and PRISMA guideline for reporting. Eligible studies were RCTs of adult (≥18 years) cardiac surgery, nurse-led inpatient interventions implemented immediately post-surgery and prior to discharge. Six databases were searched from inception to June 2025. Of 2690 records, 19 RCTs were eligible, representing 13 countries, and 3142 participants. Risk of bias varied, with only two low-risk trials. Interventions were grouped into seven domains: behavioural support; temperature management and comfort strategies; pain and symptom management; wound care; infection prevention; respiratory and pulmonary function; and post-operative recovery, mobilization, and hydration. Across these domains, nurse-led interventions were generally feasible, safe, and positively affected patient comfort, physiological stability, symptom relief, and aspects of functional recovery. CONCLUSION: Nurse-led inpatient interventions contribute meaningfully to inpatient post-operative recovery in cardiac surgery, although the broader cardiac surgical nursing scope is underrepresented in RCTs. This review provides a foundation for developing further high-quality research, peer-reviewed interdisciplinary practice guidelines, and strengthening the scope and recognition of cardiac surgical nursing as a distinct specialty. REGISTRATION: PROSPERO-CRD420251063851.

Humans↗
PubMed1978

Electrocardiographic pseudo-infarction pattern: appearance with a large posterior pericardial effusion after cardiac surgery.

Two patients with a large posterior pericardial effusion after cardiac surgery presented with electrocardiographic precordial Q waves without evidence of myocardial infarction. Resolution of the pericardial fluid resulted in the disappearance of the Q waves. Changes in conductivity and orientation of the heart within the pericardial space, along with a decrease in QRS voltage, could lead to the loss of initial R waves in the precordial leads, eventually resulting in a QS complex. Care should be taken in interpreting the electrocardiogram after cardiac surgery in patients with a large posterior pericardial effusion. The clinical course along with serial electrocardiographic and echocardiographic tracings should be helpful in identifying this false infarction pattern.

Adult↗
PubMed1978

Cardiac risk factors and complications in non-cardiac surgery.

In an attempt to assess cardiac risk in non-cardiac surgery, 1001 patients over 40 years of age who underwent major operative procedures were examined preoperatively, observed through surgery, studied with at least one postoperative electrocardiogram, and followed until hospital discharge or death. Documented postoperative myocardial infarction occurred in only 18 patients; though most of these patients had some pre-existing heart disease, there were few preoperative factors which were statistically correlated with postoperative infarction. Postoperative pulmonary edema was strongly correlated with preoperative heart failure, but 21 of the 36 patients who developed pulmonary edema did not have any prior history of heart failure. Nearly all of these 21 patients were elderly, had abnormal preoperative electrocardiograms, and had intraabdominal or intrathoracic surgery. In the absence of an acute infarction, bifascicular conduction defects, with or without PR interval prolongation, never progressed to complete heart block. Spinal anesthesia protected against postoperative heart failure but not against other cardiac complication. By multivariate regression analysis, postoperative cardiac death was significantly correlated with (a) myocardial infarction in the previous 6 months; (b) third heart sound or jugular venous distention immediately preoperatively; (c) more than five premature ventricular contractions per minute documented at any time preoperatively; (d) rhythm other than sinus, or premature atrial contractions on preoperative electrocardiogram; (e) age over 70 years; (f) significant valvular aortic stenosis; (g) emergency operation; (h) a 33% or greater fall in systolic blood pressure for more than 10 minutes intraoperatively. Notably unimportant factors included smoking, glucose intolerance, hyperlipidemia, hypertension, peripheral atherosclerotic vascular disease, angina, and distant myocardial infarction.

Adult↗
PubMed1979

Effects of cardiac surgery on renal function in children.

In order to determine whether cardiac surgery with cardiopulmonary bypass (CPB) affects renal function in children, glomerular filtration rate (GFR and renal plasma flow (RPF) were determined preoperatively and on the second postoperative day by a single-injection, urineless technique in a randomly selected group of 10 children. The GFR was 126.7 +/- 6.8 ml. per minute per 1.73 sq. M. (mean +/- S.E.M.) before the operation and 127.4 +/- 16.2 on the second postoperative day (p = 0.95). The RPF was 541.7 +/- 80.6 ml. per minute per 1.73 sq. M. preoperatively and 536.0 +/- 82.1 on the second postoperative day (p = 0.8 to 0.9). The results in this group of 10 children indicate that renal function is not markedly altered 2 days after cardiac surgery with CPB and deep hypothermia with circulatory arrest. The study also revealed a falsely decreased creatinine clearance. This was due to an increase in postoperative plasma creatinine values, probably related to an increase in plasma noncreatinine chromogens.

Acute Kidney Injury↗
PubMed1977

A critical look at temporary ventricular pacing following cardiac surgery.

The effect of atrial, ventricular, and atrioventricular (A-V) sequential pacing on cardiac output (CO) was evaluated in patients within 24 hours after cardiac surgery. In patients with normal sinus rhythm, ventricular pacing reduced CO by as much as 42% (average, 14%), whereas atrial and A-V sequential pacing at the same rate increased CO by averages of 13% and 19%, respectively. In patients with junctional rhythm, increase of the heart rate by ventricular pacing produced an increase in CO, however, and an additional 25% increase in CO could be obtained by atrial or A-V sequential pacing at the same rate. Atrial or A-V sequential pacing was superior to ventricular pacing at the same rate and they are the preferred methods for temporary carciac pacing in the postoperative period. In suitable cases elective A-V sequential pacing is an effective method for increasing CO after cardiac surgery.

Adult↗
PubMed1976

[Membrane oxygenators in cardiac surgery: progress].

This study tries to define if the membrane oxygenators are available during cardiac surgery under E.C.C., and if their performance are superior to those of conventional oxygenators. Two series of research are done. In the first one, we compare performance of two membrane oxygenators: the Rhône-Poulenc heart-lung machine (10 cases) and the Travenol TMO Teflo machine (100 cases). The general impression is good: the two proposed systems seem to be perfectly well adapted to surgical utilization conditions, avoiding excessive ventilations and eventually allowing to keep on E.C.C. in postoperative. In the second part of this work, two series of patients are studied, one oeprated under membrane oxygenator (Teflo), the second under bubble oxygenator (Bentley Q 100). Comparative study shows small differences between the two groups. Only the post-operative enzymatic profile is clearly for the membrane oxygenator which also insure a waking and a postoperative recovery of highest quality. These first observations justify to keep on using of membrane oxygenators in cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1977

Cardioplegia without fibrillation or defibrillation in cardiac surgery.

A group of 176 patients undergoing cardiac surgery utilizing a technique of rapid core hypothermic cardioplegia with a hyperosmotic solution is presented. A cold, 2 to 4 degrees C hyperosmotic (396 mOsm) perfusate, injected under pressure, induced cardiac arrest without fibrillation within 2 to 4 seconds in every instance. At the end of each procedure, flushing of the cold solution out of the coronary system re-establishes spontaneous normal sinus cardiac rhythm in 96% (119 of 124) of coronary surgical procedures, 69% (11 of 16) of aortic valve replacements, 62% (10 of 16) of mitral valve replacements, 55% (five of nine) of aortic valve replacements combined with multiple coronary grafting, 57% (four of seven) of mitral valve replacement combined with multiple coronary grafting, and in 50% (two of four) of double valve replacements. Combined core and topical hypothermia with ice slush used in valve replacements and combined valve with coronary operations allowed periods of total ischemia up to 134 minutes without signs of detectable myocardial damage.

Aged↗
PubMedDate not supplied

[Jugular phlebogram after cardiac surgery].

We studied several parameters of the jugular flebogram in 70 patients who had undergone cardiac surgery. Fifty six of them were on sinusal rithm and 14 in auricular fibrillation. We found among them 39 who had undergone commissurotomy and 16 who had got valvular prothesis. The results of these studies were analyzed and compared with those of 94 normal subjects, taking in consideration the type of surgical intervention and the time elapsed since the operation was performed--the latter in the more numerous group. It is interesting to observe that the sinus grows deeper after the intervention so making the relation xv/yv lower than the unit in 33% of the patients maintaining sinusal rithm. This alteration remained stationary during some years in some of the cases, the results suggesting a greater frequency during the first months of the post-operatory period. We didn't find any relation of this morphologic alteration with the presence of a pericardial construction, pulmonary hypertension, valvular injuries with repercussion on the right heart or modifications on the nenous pressure which we think due to functional changes following the pericardiotomy. It is interesting to observe these mechanographic signs in relation with the post-operatory period of cardiac surgery, but we must avoid hypervaluation of those cases suspicious of pericardial constriction.

Adolescent↗
PubMed1978

Evaluation of lactate dehydrogenase isoenzyme patterns in serum of patients undergoing cardiac surgery.

Serial determinations of serum lactate dehydrogenase (LD) isoenzymes were performed in 50 patients undergoing cardiac surgery for coronary artery bypass and heart valve replacement. A sequence of LD isoenzyme patterns was established in the patients with uncomplicated recovery. These patterns served as controls for the detection of abnormal patterns associated with clinical complications. Perioperative myocardial infarction was detected in seven patients by a characteristic reversal of the LD1:LD2 ratio. These studies established that accurate determination of LD isoenzymes improved their diagnostic specificity. These isoenzymes were determined by (1) using the same technique for tissues and for serum samples, (2) applying a volume of serum containing a standard amount of enzymatic activity, and (3) making a clear separation, which allows accurate quantitation. This test can provide useful information to the surgeon for the evaluation of operative procedures and to the clinician for the appropriate management of the patient undergoing cardiac surgery.

Adult↗
PubMedDate not supplied

Pacing studies after cardiac surgery.

The diagnostical use of pacemaker after cardiac surgery is presented. Temporary pacemaker electrodes have been inserted during surgery into the wall of atrial and ventricular myocardium. With the aid of these electrodes, an analysator wire of 6 volts, and a Medtronic 5840 type pacemaker electrophysiological studies have been performed. The diastolic and supernormal stimulation threshold, the duration of atrial and ventricular relative refractory period were measured, the clinical significance of latency was analysed. It has been found that decrease of stimulation threshold, shortening of relative refractory period, and appearance of latency phenomenon promote arrhythmias. By investigating the conduction capacity of atrioventricular conduction system, latent conduction disturbances could be revealed, and a significant difference could be demonstrated between the atrioventricular conduction of WPW syndrome and that of other kinds of PR interval shortening. In addition the optimal heart rate requirement (optimal pacing rate) following heart surgery was defined. These parameters present more precise information on the electrophysiological condition of the heart than does the generally used ECG monitoring. When these parameters are repeatedly determined, the significance of patient's arrhythmias can be evaluated more safely and accurately; in a number of cases, even in the absence of any rhythm disturbances, impending arrhythmias can be predicted. "Pacemaker monitoring" of the postoperative heart patients, therefore, affords greater possibility for preventing the development of major cardiac arrhythmias.

Adolescent↗
PubMed1975

Optimal resources for cardiac surgery. Guidelines for program planning and evaluation.

This updated and expanded planning guideline describes the optimal environment in which cardiac surgery can be performed effectively and safely and suggests criteria for evaluating existing facillities and for long-range hospital planning. The status of cardiac surgery is reviewed and measures are provided for assessing a hospital's ability to support a cardiac surgical service. Recommendations are given for appropriate case loads, administrative arrangements, and professional staff qualifications and relationships. The emerging role of the nurse is considered and requirements are enumerated for allied clinical supporting services. Special criteria are provided for pediatric cardiac surgical units and detailed specifications are given for the hospital's physical plant and equipment including a protocol for checking the electrical safety of surgical suites. A data base is suggested for taking regular inventory of community cardiac surgical programs.

Cardiac Surgical Procedures↗
PubMed1975

Report of the Inter-Society Commission for Heart Disease Resources. Optimal resources for cardiac surgery guidelines for program planning and evaluation.

This updated and expanded planning guideline describes the optimal environment in which cardiac surgery can be performed effectively and safely and suggests criteria for evaluating existing facilities and for long-range hospital planning. The status of cardiac surgery is reviewed and measures are provided for assessing a hospital's ability to support a cardiac surgical service. Recommendations are given for appropriate case loads, administrative arrangements, and professional staff qualifications and relationships. The emerging role of the nurse is considered and requirements are enumerated for allied clinical supporting services. Special criteria are provided for pediatric cardiac surgical units and detailed specifications are given for the hospital's physical plant and equiptment including a protocol for checking the electrical safety of surgical suites. A data base is suggested for taking regular inventory of community cardiac surgical programs.

Cardiac Surgical Procedures↗
PubMed1979

Relationship between renin activity and aldosterone release in the patients with low cardiac output syndrome after open cardiac surgery.

Plasma renin activity and aldosterone concentration were measured by radioimmunoassay technique in seven patients with low cardiac output syndrome after open cardiac surgery. Plasma renin activity and aldosterone concentration markedly increased, and plasma renin activity was well correlated with plasma aldosterone concentration. Plasma renin activity and aldosterone concentration, however, had no direct correlation with plasma sodium and potassium concentration or administered doses of inotropic agent, potassium and diuretic. Sodium and potassium balance was closely correlated with plasma aldosterone concentration. In the present study, it was suggested that the secondary hyperaldosteronism following low cardiac output syndrome after open cardiac surgery was mainly induced by the increased release of renin and that it influenced on the balance of sodium and potassium metabolism under such disturbed circulatory circumstances.

Adolescent↗
PubMed1976

Clinical and hemodynamic criteria for use of the intra-aortic balloon pump in patients requiring cardiac surgery.

In order to establish criteria for elective use of the intra-aortic balloon pump (IABP) in patients having cardiac surgery, we conducted a retrospective study of 43 patients who required counterpulsation, because of inability to be weaned from cardiopulmonary bypass, between May, 1972, and June, 1974. Patients in cardiogenic shock preoperatively were excluded. The 43 patients included 23 (Group A) who had severe preoperative left ventricular dysfunction with a mean cardiac index less than 1.8 L. per minute per square meter, ejection fraction less than 30 per cent, and end-diastolic pressure greater than 22 mm. Hg; 20 patients (Group B) had a combination of moderate cardiac dysfunction (cardiac index less than 2.2, ejection fraction less than 40, end-diastolic pressure less than 18) in the presence of acute infarction or severe aortic stenosis (gradient greater than 80 mm. Hg) with or without coronary disease. An inverse relationship was noted between survival and delay from completion of operation to the use of 1ABP. Thirty-two of 43 patients were weaned off bypass and were balloon assisted for 12 to 96 hours postoperatively; 25 patients were discharged (58 per cent). In Subgroup A, 14 of 23 (60 per cent) and, in Subgroup B, 9 of 20 (45 per cent) were long-term survivors. Based on these findings, 45 patients were operated upon between June, 1974, and December, 1975, with elective use of 1ABP and were assessed by serial hemodynamic studies. Sixteen had severe preoperative left ventricular dysfunction similar to Subgroup A and 29 had moderate dysfunction in combination with pathology similar to Subgroup B. Fifteen of these patients were hemodynamically unstable at time of arrival in the operating room; 1ABP was inserted under local anesthesia. Thirty-nine patients (87 per cent) were weaned off bypass and were hospital survivors. In Subgroup A, 13 of 16 (81 per cent) and, in Group B, 21 of 29 (72 per cent) were long-term survivors. Criteria for elective use of 1ABP in cardiac surgery should include severe preoperative left ventricular dysfunction or a combination of moderate dysfunction with coronary or valvular pathology. Elective 1ABP improves the survival with trivial iatrogenic morbidity.

Assisted Circulation↗
PubMed1977

[Psychiatric and neurological complications associated with cardiac surgery (author's transl)].

The following problems are discussed as the result of an own investigation done with 150 patients after cardiac surgery: 1. the differences in incidence of cerebral complications understood as 2. a probleme of qualitatively different psychopathological and neurological syndromes. 3. Causes and relationship between the clinical stages of heart-disease and neuropsychiatric complications with special regard to the question 4. congenital heart-disease versus aquired heart-disease. 5. The role of extracorporeal circulation. 6. Remarks on the role of microembolism associated with open cardiac surgery. 7. Hereditary factors as the cause for specific psychopathological reactions.

Adult↗
PubMed1978

Levels of plasma cyclic AMP and insulin in cardiac surgery.

Cyclic AMP is a common second messenger for a variety of hormones such as catecholamine, glucagon, and growth hormone, which are affected by cardiac surgery. Changes in plasma cyclic AMP level may thus reflect an altered hormonal milieu. The effects of open-heart surgery on plasma cyclic AMP and its relation with serum insulin were studied in 33 adult patients who underwent cardiac surgery with cardiopulmonary bypass. Plasma cyclic AMP levels were markedly elevated during cardiopulmonary bypass and returned toward normal within several days after the operation. The serum insulin concentration remained low, and no positive correlation was found with plasma cyclic AMP level. The responses were similar in patients who had aorta-coronary bypass grafts and those who had valve replacements.

Cardiac Surgical Procedures↗
PubMed1977

[Kidney failure after ectracorporeal circulation in cardiac surgery].

The renal function of 113 patients undergoing cardiac surgery under ECC was studied. In 32 p. 100 of the cases renal involvement was noted which was moderate in 18 p. 100 of the cases, severe in 10 p. 100 of the cases and anuric in 4 p. 100 of the cases. Valvular surgery was complicated once in every three cases by renal involvement, the repair of congenital malformations once out of every two cases, and coronary surgery in 17 p. 100 of the cases. The fall in renal perfusion represents the essential factor in this renal involvement, which should be avoided by the maintenace during ECC of a high output level and a satisfactory perfusion pressure and by the recovery of correct hemodynamics after the intervention.

Acute Kidney Injury↗