Psychosocial Factors Associated with Transfer Anxiety among Open Heart Surgery Patients Transferred from the Intensive Care Unit to the General Ward

Introduction: Patient’s transfer from the intensive care unit (ICU) to the general ward indicates their improving health status. However, the transfer produces anxiety when patients enter an unfamiliar environment with different care protocols and circumstances. Objectives: This study aimed to examine the level of ICU transfer anxiety among open heart surgery patients and determine the psychosocial factors associated with ICU transfer anxiety among open heart surgery patients. Methods: Data were collected in a cardiac center in Kathmandu City, Nepal among 95 open heart surgery patients within 24 hours of their transfer from an ICU to a general ward. The study used four self-reported questionnaires, namely the modified Mishel Uncertainty in Illness Scale for Adults, modified Brief COPE Inventory, Nurses’ Support Questionnaire, and State Anxiety Inventory. Results: Fifty-two patients (54.7%) had a high level of transfer anxiety. Spearman’s rank correlation showed that uncertainty in illness, coping, and nurses’ support were significantly related to transfer anxiety (p < 0.001). Conclusion: The results of this study suggest nurses to address uncertainty in illness of the patients, improve their coping abilities, and provide need-based nursing support to them during the transitional phase. Besides, clinicians and governmental agencies should contribute to implication of transitional guidelines, which can reduce transfer anxiety and promote health and recovery of the patients.

Renal Outcomes and Myocardial Performance after On-Pump Beating Heart versus Conventional On-Pump Surgery in Patients with Preoperative Low Glomerular Filtration Rate

Objective: Acute kidney disease develops 16% - 30% of patients with preoperative impaired renal functions. Our aim of this study was to compare postoperative renal outcomes using two open heart surgery techniques, on-pump beating heart (OPBH) and conventional on-pump (COP), in patients who have preoperative low glomerular filtration rate (eGFR) as an indicator of creatinine clearance. Methods: From 2004 to 2015, 341 patients with preoperative creatinine clearance were lower than 90 ml/min/1.73m2 were selected for this study. On-Pump beating heart was performed in 111 patients (Group I). Conventional on-pump technique was used in 200 patients. In the remaining patients, we measured postoperative Tumor Necrosis Factor Alpha (TNF-alpha), cardiac troponin I (cTn-I), Brain natriuretic peptid (NT-Pro- BNP), creati-nine (Cr), blood urea nitrogen (BUN) and postoperative eGFR daily until day four after surgery. Results: There were no differences in baseline levels of TNF-alpha, NT-Pro-BNP, BUN, cTn-I, Cr levels between the groups. Cardiopulmonary bypass (CPB) time were much longer and cumulative inotrope use was significantly higher in patients underwent COP (P Conclusion: Our study showed that on-pump beating heart CABG technique provides a morbidity benefit and is associated with a lower risk of peroperative LOS in patients with mild renal disfunction. Our study results suggest that OPBH is superior to the COP in terms of postoperative renal injury and cardiac mediators.

Combination of balanced ultrafiltration with modified ultrafiltration attenuates pulmonary injury in patients undergoing open heart surgery

Objective To explore the effects of ultrafiltration technique in preventing and relieving pulmonary injury in children undergoing open heart surgery and cardiopulmonary bypass (CPB). Methods Thirty cases with congenital heart defects were divided into a control group and an experimental group. In the control group,conventional cardiopulmonary bypass was used without ultrafiltration; while in the experimental group,cardiopulmonary bypass with balanced ultrafiltration and modified ultrafiltration were used. Pulmonary static compliance (C stat ),airway resistance (R aw ),alveolar-arterial oxygen difference (A-a DO 2),hematocrit (HCT),serum albumin (Alb),interleukin-6 (IL-6),endothelia-1 (ET-1) and thromboxane (TXB 2) were measured. Results The pulmonary function was improved,HCT and serum albumin concentrations were increased,and some harmful medium-size solutes were decreased in the experimental groups compared with the control group.Conclusions Combination of balanced ultrafiltration with modified ultrafiltration can effectively concentrate blood,exclude harmful inflammatory mediators,and attenuate lung edema and inflammatory responsive pulmonary injury.

Combined Hepatocardiac Hydatid Cystic Disease

Cardiac echinococcus is a serious problem. Although it is rare, it could cause dangerous complications like anaphylactic shock which could be fatal. In our case a 14-year-old female complained with the intermittent chest pain and had combined cystic lesions in the heart and the liver. The liver cyst was treated conservatively, while the heart cyst was excised by open heart surgery.