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At least 19 recordsLinked to original sources
PubMed1978

A comparative study of IPPB, the incentive spirometer, and blow bottles: the prevention of atelectasis following cardiac surgery.

Following cardiac operations, 145 patients were treated with either intermittent positive-pressure breathing (IPPB), blod bottles, or an incentive spirometer in an attempt to alter the incidence of atelectasis. Pulmonary complications occurred in 30% of the patients receiving IPPB, 15% of those using an incentive spirometer, and 8% of those using blow bottles. Gastrointestinal side-effects occurred in 20% of the IPPB group and were rare in other groups. The cost of IPPB is also considerably greater than either incentive spirometry or blow bottles. IPPB is not essential to prevention of atelectasis in postoperative cardiac surgical patients and may be inferior to other methods.

Cardiac Surgical Procedures↗
PubMed1979

Myocardial infarct imaging after cardiac surgery.

One hundred and nineteen patients undergoing cardiac surgery had postoperative myocardial imaging performed with technetium pyrophosphate in order to assess the incidence of perioperative myocardial infarction. Fifty-six patients had only coronary artery bypass graft (CABG) surgery, of whom 13(23%) had a positive scintigram. Thirteen patients had CABG with other cardiac surgery and six (46%) had a positive scintigram. Fifty patients had other cardiac surgery but no CABG, and of these eight (16%) had a positive scintigram. The overall incidence of positive scintigrams was 23%, whereas definite or probable ECG diagnosis of infarction was present in 14 patients (12%). Serum levels of cardiac enzymes were higher in patients with positive scintigrams, but this finding did not consistently reach statistical significance. The use of a left ventricular vent during surgery did not correlate with a positive scintigram, nor did the total time on cardiopulmonary bypass or aortic cross-clamping. Patients having cardiac surgery, including CABG and valve replacement, have a 23% overall incidence of positive scintigrams. This suggests that the incidence of infarction after cardiac surgery is higher than can be recognized from the conventional criteria of ECG and enzyme changes.

Cardiac Surgical Procedures↗
PubMed1977

An overview of cardiac surgery.

The scope of cardiac surgery has extended greatly in the last decade, advances being particularly in the areas of perfusion technology, ischaemic heart disease, and congenital defects in the infant. This paper sets out to summarize accepted current practice in the surgery of the heart and great vessels. Principles have been emphasized at the expense of detail, since the aim has been to present information which might be of interest to surgeons in general. Some aspects which have a special reievance to general surgical practice have been grouped separately for the sake of emphasis.

Adult↗
PubMed2026

Sex Differences in Postoperative Recovery and Mortality After High-Risk Cardiac Surgery: A Propensity Score-Matched Post Hoc Analysis of the SUSTAIN-CSX Trial.

BACKGROUND: Sex-related differences after cardiac surgery remain controversial because women often present with higher baseline risk and complexity than men. We performed a post hoc propensity score-matched analysis of the SUSTAIN-CSX (Sodium Selenite Administration in Cardiac Surgery) trial to evaluate sex differences in mortality, postoperative complications, and recovery after high-risk cardiac surgery. METHODS: Of 1394 trial participants, 1386 had complete data. Women were matched 1:1 to men using nearest-neighbor propensity score matching based on age and European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), with exact matching on surgical category, yielding 327 female-male pairs. Prespecified sensitivity analyses adjusted for frailty, baseline hemoglobin, renal disease, left ventricular ejection fraction, previous myocardial infarction, preoperative medications, and baseline creatinine. RESULTS: In the primary matched analysis, 180-day survival did not differ between women and men (log-rank P=0.086; unadjusted hazard ratio, 1.80 [95% CI, 0.91-3.55]; P=0.091). In descriptive matched comparisons, women had numerically longer intensive care unit stay (median, 3 days [quartile 1, quartile 3 (Q1, Q3)=1, 6 days] versus 2 days [Q1, Q3=1, 5 days]) and hospital stay (median, 10 days [Q1, Q3=7, 18 days] versus 9 days [Q1, Q3=6, 16 days]; P=0.292), whereas major postoperative complications were similar. In adjusted sensitivity analyses accounting for the matched design and residual imbalance, female sex remained associated with longer intensive care unit stay (adjusted incidence rate ratio [IRR], 1.8 [95% CI, 1.2-2.9]; P=0.009) and hospital stay (adjusted IRR, 1.4 [95% CI, 1.0-1.9]; P=0.031). Mortality sensitivity analyses were model-dependent. CONCLUSIONS: In this propensity score-matched cohort of high-risk cardiac surgery patients, women showed a longer postoperative recovery trajectory in adjusted analyses, whereas mortality findings were sensitive to model specification and should be interpreted cautiously. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02002247.

Aged↗
PubMed1979

Constrictive pericarditis: early and late complication of cardiac surgery.

Constrictive pericarditis is not considered a complication of cardiac surgery. However, three cases are presented in which equalization of diastolic pressures and the ventricular pressure pattern of early diastolic dip-late diastolic plateau, characteristic of restrictive disease, appeared after cardiac surgery. In one patients cardiac constriction developed less than 2 weeks after surgery, and loculated clotted and unclotted viscous blood was removed from the pericardial space. In the other two patients the pericardial space was obliterated by dense adhesions. Thus constrictive pericarditis should be considered in postoperative patients who either do not recuperate satisfactorily after surgery or whose condition deteriorates after initial recovery.

Aged↗
PubMed1978

Deep hypothermia in infant cardiac surgery.

The value of infant cardiac surgery using deep hypothermia remains a debate. A steady number of cardiac centers have consented to this approach in spite of some filibuster. Physiologists are frightened, anesthetists may find it cumbersome, but surgeons using it enjoy the ease of correction in a bloodless and relaxed heart. The cardiologists may document acceptable results, but we also need the alert feedback from the provider of long-term health care--the pediatrician--to document possible flaws of this pristine modality. This article is intended to familiarize the pediatrician with the method of deep hypothermia: its origin, application, and appeal for consumer protection.

Cardiac Surgical Procedures↗
PubMed2026

Pulmonary artery catheters or central venous catheters for cardiac surgery: the PUMA Pilot randomised clinical trial.

INTRODUCTION: Pulmonary artery catheters are used widely in cardiac surgery despite observed associations with worse outcomes and guidelines that recommend against their routine use. No adequately powered randomised trials are available. METHODS: The PUMA Pilot was a multicentre, randomised, parallel assignment, open-label, pilot and feasibility trial conducted at three tertiary cardiac surgery centres. Eligible patients were adults undergoing coronary artery bypass grafting, aortic valve replacement or surgery on the aortic root or ascending aorta with or without aortic valve replacement, with a predicted surgical mortality of <&#x2009;2%. Patients were allocated randomly to receive a pulmonary artery catheter or a central venous catheter inserted immediately before surgery. The primary feasibility outcome was protocol compliance, defined as receiving the assigned intervention without crossover. Secondary feasibility outcomes were eligibility rate; recruitment proportion and rate; data completeness; and rate of clinician refusal. RESULTS: We screened 480 patients and 206 (43%) were eligible; 150/203 (74%) approached provided informed consent. Three of 206 (1%) eligible patients were not included due to clinician refusal. Of 149 patients who were randomised, 76 were assigned to the pulmonary artery catheter group and 73 to the central venous catheter group. For the primary feasibility outcome, 147 patients (99%) received the allocated intervention. Data were complete for 144 (97%) patients. Median (IQR [range]) days alive and at home at 30&#x2009;days was 23.7 (21.9-24.7 [7.0-26.0]) in the pulmonary artery catheter group and 22.9 (20.8-23.9 [8.6-25.8]) in the central venous catheter group. Acute kidney injury occurred in 26/76 (34%) patients in the pulmonary artery catheter group and 14/73 (19%) in the central venous catheter group. DISCUSSION: A randomised trial of pulmonary artery catheters compared with central venous catheters in low-risk cardiac surgery is feasible. Such a trial would address significant practice variability and inform international guidelines.

Humans↗
PubMed2026

Effects of Adding Incentive Spirometry to Hospital-Based Cardiovascular Rehabilitation on Pulmonary Complications, Hospital Length of Stay, and Clinical-Functional Recovery After Cardiac Surgery: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: This study investigated the effects of combining incentive spirometry with cardiac rehabilitation compared with cardiac rehabilitation alone on postoperative pulmonary complications, clinical-functional recovery, and hospital length of stay in patients undergoing cardiac surgery. METHODS: Randomized controlled trial was conducted from May 2019 to October 2023 in two hospitals, including 46 inpatients undergoing cardiac surgery. Participants were assigned to incentive spirometry plus cardiac rehabilitation or cardiac rehabilitation alone. Both interventions were performed twice daily; spirometry used a volume-oriented device, and rehabilitation followed a seven-step protocol (2-4 METs). Outcomes included postoperative pulmonary complications, functional capacity (6-min walk test), handgrip strength, respiratory muscle function, and length of hospital stay. RESULTS: The incentive spirometry associated with cardiac rehabilitation group had a longer extracorporeal circulation time (98&#xa0;&#xb1;&#xa0;26&#xa0;min) than the cardiac rehabilitation group (76&#xa0;&#xb1;&#xa0;1; p&#xa0;=&#xa0;0.008). Both groups showed a postoperative decline in respiratory muscle strength, and walking distance (MD: -64.37&#xa0;m; 95% CI: [-24.1; -104.6]; d&#xa0;=&#xa0;0.71), with no difference in postoperative pulmonary complications and handgrip strength. The incentive spirometry associated with cardiac rehabilitation group did not significantly differ on postoperative hospital stay compared with the cardiac rehabilitation group (MD: -1&#xa0;day; 95% CI: [-4.71; 2.71]; d&#xa0;=&#xa0;-0.19). CONCLUSIONS: In this study, no additional benefit was observed with the addition of incentive spirometry to cardiac rehabilitation compared with cardiac rehabilitation alone. No significant differences were detected between groups in postoperative pulmonary complications, hospital length of stay, or clinical-functional recovery among individuals undergoing cardiac surgery. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC) under the number RBR-8tsjf97.

Aged↗
PubMed1979

[Secondary tamponade following cardiac surgery with reference to 3 cases].

Secondary tamponnade after cardiac surgery occurs after a variable period, generally between the 15th day and the 5th post-operative week. Although this is a rare complication, it occurred three times in a consecutive series of 225 patients (1.3 p. 100). Based on this short experience as compared to the number of cases already published, the authors discuss their opinions on: -- the factors of inflammation and post-operative anticoagulation which predispose to this complication; -- the progress in diagnosis brought about by echocardiography; -- the minimal suggested management of pericardocentesis completed or not by surgical drainage; -- the possibilities of prevention based on prolonged follow-up of patients who present post-operative "pericardial problems". In this way it may be possible to eliminate a not negligeable cause of secondary mortality after cardiac surgery.

Aged↗
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 (&#x2265;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↗
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↗