Cardiac rehabilitation after cardiac surgery:An important underutilized treatment strategy

Physical inactivity remains in high levels after cardiac surgery,reaching up to 50%.Patients present a significant loss of functional capacity,with prominent muscle weakness after cardiac surgery due to anesthesia,surgical incision,duration of cardiopulmonary bypass,and mechanical ventilation that affects their quality of life.These complications,along with pulmonary complications after surgery,lead to extended intensive care unit(ICU)and hospital length of stay and significant mortality rates.Despite the well-known beneficial effects of cardiac rehabilitation,this treatment strategy still remains broadly underutilized in patients after cardiac surgery.Prehabilitation and ICU early mobilization have been both showed to be valid methods to improve exercise tolerance and muscle strength.Early mobilization should be adjusted to each patient’s functional capacity with progressive exercise training,from passive mobilization to more active range of motion and resistance exercises.Cardiopulmonary exercise testing remains the gold standard for exercise capacity assessment and optimal prescription of aerobic exercise intensity.During the last decade,recent advances in healthcare technology have changed cardiac rehabilitation perspectives,leading to the future of cardiac rehabilitation.By incorporating artificial intelligence,simulation,telemedicine and virtual cardiac rehabilitation,cardiac surgery patients may improve adherence and compliance,targeting to reduced hospital readmissions and decreased healthcare costs.

Safety and effectiveness of neuromuscular electrical stimulation in cardiac surgery:A systematic review

BACKGROUND Lack of mobilization and prolonged stay in the intensive care unit(ICU)are major factors resulting in the development of ICU-acquired muscle weakness(ICUAW).ICUAW is a type of skeletal muscle dysfunction and a common complication of patients after cardiac surgery,and may be a risk factor for prolonged duration of mechanical ventilation,associated with a higher risk of readmission and higher mortality.Early mobilization in the ICU after cardiac surgery has been found to be low with a significant trend to increase over ICU stay and is also associated with a reduced duration of mechanical ventilation and ICU length of stay.Neuromuscular electrical stimulation(NMES)is an alternative modality of exercise in patients with muscle weakness.A major advantage of NMES is that it can be applied even in sedated patients in the ICU,a fact that might enhance early mobilization in these patients.AIM To evaluate safety,feasibility and effectiveness of NMES on functional capacity and muscle strength in patients before and after cardiac surgery.METHODS We performed a search on Pubmed,Physiotherapy Evidence Database(PEDro),Embase and CINAHL databases,selecting papers published between December 2012 and April 2023 and identified published randomized controlled trials(RCTs)that included implementation of NMES in patients before after cardiac surgery.RCTs were assessed for methodological rigor and risk of bias via the PEDro.The primary outcomes were safety and functional capacity and the secondary outcomes were muscle strength and function.RESULTS Ten studies were included in our systematic review,resulting in 703 participants.Almost half of them performed NMES and the other half were included in the control group,treated with usual care.Nine studies investigated patients after cardiac surgery and 1 study before cardiac surgery.Functional capacity was assessed in 8 studies via 6MWT or other indices,and improved only in 1 study before and in 1 after cardiac surgery.Nine studies explored the effects of NMES on muscle strength and function and,most of them,found increase of muscle strength and improvement in muscle function after NMES.NMES was safe in all studies without any significant complication.CONCLUSION NMES is safe,feasible and has beneficial effects on muscle strength and function in patients after cardiac surgery,but has no significant effect on functional capacity.

Incidence and peri-operative risk factors for development of acute kidney injury in patients after cardiac surgery:A prospective observational study

BACKGROUND Patients admitted to intensive care unit(ICU) after cardiac surgery develop acute kidney injury(AKI) immediately post-operation. We hypothesized that AKI occurs mainly due to perioperative risk factors and may affect outcome.AIM To assess peri-operative risk factors for AKI post cardiac surgery and its relationship with clinical outcome.METHODS This was an observational single center, tertiary care setting study, which enrolled 206 consecutive patients, admitted to ICU after cardiac surgery. Patients were followed-up until ICU discharge or death, in order to determine the incidence of AKI, perioperative risk factors for AKI and its association with outcome.Univariate and multivariate logistic regression analysis was performed to assess predictor variables for AKI development.RESULTS After ICU admission, 55 patients(26.7%) developed AKI within 48 h. From the logistic regression analysis performed, high EuroScore Ⅱ(OR: 1.18;95%CI: 1.06-1.31, P = 0.003), white blood cells(WBC) pre-operatively(OR: 1.0;95%CI: 1.0-1.0, P = 0.002) and history of chronic kidney disease(OR: 2.82;95%CI: 1.195-6.65, P = 0.018) emerged as independent predictors of AKI among univariate predictors. AKI that developed AKI had longer duration of mechanical ventilation [1113(777–2195) vs 714(511–1020) min, P = 0.0001] and ICU length of stay [70(28–129) vs 26(21–51) h, P = 0.0001], higher rate of ICU-acquired weakness(16.4% vs 5.3%, P =0.015), reintubation(10.9% vs 1.3%, P = 0.005), dialysis(7% vs 0%, P = 0.005), delirium(36.4% vs 23.8%, P = 0.001) and mortality(3.6% vs 0.7%, P = 0.046).CONCLUSION Patients present frequently with AKI after cardiac surgery. EuroScore Ⅱ, WBC count and chronic kidney disease are independent predictors of AKI development. The occurrence of AKI is associated with poor outcome.

Application progress of nursing intervention in cardiac surgery

As a stressor,cardiac surgery affects the physiology and psychology of patients,as well as their postoperative recovery.Patients tend to worry about cognitive deficiency,pain,discomfort,the risk of death,sleep,complications,and other factors,resulting in stress and anxiety.Moreover,serious adverse events,such as circulatory and respiratory dysfunction and infection,tend to occur after cardiac surgery and increase the economic burden on patients.Therefore,appropriate nursing interventions should be selected to strengthen patients’cognitive levels,compliance,and postoperative practices to accelerate their recovery,reduce complications,and shorten hospital stays so as to contribute to patients’lives and health.

Short- and Long-Term Outcomes of Cardiac Surgery in Kidney Transplant Recipients: A Review—Kidney Transplant and Cardiac Surgery

Background: Cardiovascular diseases remain the leading cause of death in kidney transplant patients and increasing proportion of these patients are referred to cardiac surgery. Data on short- and long-term outcomes of these patients are limited to single center reports with no randomized trials and no prospective studies published previously. The aim of this review was to report both short- and long-term outcomes of these patients. Methods: Literature review was conducted using three databases from inception to June 2022. Multiple search terms were used and limited to English language. Thirty-one relevant articles were included. Outcomes of interest were short-term mortality, long-term survival, renal allograft failure and infection in kidney transplant patients undergoing cardiac surgery. Results: Cardiac risk factors (diabetes mellitus, hypertension, hyperlipidemia) were prevalent in kidney transplant patients. 30-days mortality ranged across the studies from zero to 18.8%. The 1-year survival ranged from 71% - 97% and 5-years survival ranged from 31% - 95.7%. Commonest causes of death were cardiac and sepsis. Multiple predictors of mortality were reported. Postoperative acute kidney injury ranged from 0 - 74% with most of them being transient. Kidney graft failure ranged from 0 - 45% with 5-year kidney graft survival rates ranged between 37% - 80%. Post-operative infection rates ranged from 1% - 25% and the most common sites were pneumonia followed by septicemia and surgical site infections. Conclusion: Cardiac surgery can be performed in kidney transplant patients with good short- and long-term results.

Incidence and Outcomes of Surgical Site Infections after Adult Cardiac Surgery: A Single-Center Experience

Background: Surgical site infections (SSIs) remain a challenging medical problem, especially in cardiac surgery patients. There is a lack of studies evaluating the rate of and outcomes of SSIs following cardiac surgeries in Saudi Arabia. Aims: This study aimed to determine the incidence of SSIs after adult cardiac surgeries that were done in Madinah Cardiac Center, Saudi Arabia. Further, to identify the outcomes and risk factors contributing to death among surgical site infection patients. Methods: This was a 6-year, single-center, retrospective cohort study that included 93 consecutive patients who underwent adult cardiac surgery between August 2016 and August 2022. All adult patients aged 18 years or older who had clinical evidence of postoperative surgical wound infection were included. Preoperative, operative, and postoperative data (early and late) were collected from medical records. Microbiological culture reports and clinical outcomes were also recorded. Results: The study revealed a 9.1% (93/1021) incidence rate of SSIs. Of the 93 patients with SSIs, 60 had superficial incisional infections and 33 had deep infections with incidence rates of 5.9% and 3.2%, respectively. In-hospital mortality due to SSI was recorded in 4 out of 93 patients with an incidence rate of 4.3%. There was a significant association between the in-hospital mortality and the type of SSIs (p = 0.014). All non-survivors had deep SSIs. The type of cardiac surgery also showed a significant association with the in-hospital mortality (p = 0.017). Furthermore, the median duration of antibiotic administration was significantly longer in the non-survivors than in the survivors (72.5 vs 17, respectively, p Conclusions: In conclusion, the incidence of surgical wound infections following cardiac surgery is not low (9.1%);of which 3.2% were deep infections. The in-hospital mortality rate after treatment of SSIs was fortunately low (4.3%), and all non-survivors had deep SSIs. The non- survivors showed a significantly longer duration of antibiotics administration than survivors. Combined CABG and valve procedures showed a higher mortality rate (75%) than the isolated procedures.

Hypoxic hepatitis in children after cardiac surgery

To the Editor: Hypoxic hepatitis(HH), also known as ischemic hepatitis or shock liver, is a liver injury characterized by necrosis of centrilobular hepatocytes with a rapid increase in serum aminotransferase levels. The incidence rate of HH among patients in the intensive care unit(ICU) was found to be 0.9%-11.9% [1]. Occurrence of HH appears to have a significant impact on the clinical outcome.

Impact and Management under Extracorporeal Circulation of a Patient with Renal Insufficiency on Dialysis with a High-Flow Arteriovenous Fistula in the Cardiac Surgery Department of the Angers Teaching Hospital about a Case and Review of the Literature

Arteriovenous fistulas have a substantial impact on systemic hemodynamics, however their effect on extracorporeal circulation is not well understood. We report our clinical observation on the management under extracorporeal circulation of a patient with renal insufficiency with a high-flow arteriovenous fistula. This is a 59-year-old man who was referred to us for surgical treatment of ischemic coronary artery disease in a context of anuric chronic renal failure. Hypothermia at 32°C is started from the start in CEC due to hyperflow at the level of the arteriovenous fistula. We performed two coronary artery bypasses of the marginal and IVA via the two internal thoracic arteries. The patient is hemofiltered in order to avoid hyperkalaemia and possibly avoid fluid overload related to filling per CEC. The clamping time was 71 minutes and the SCC lasted 141 minutes. There was no homologous transfusion in the operating room. It turns out that the input/output balance is zero at the end of the CEC. The postoperative course was simple.

Sonographic muscle mass assessment in patients after cardiac surgery

BACKGROUND Patients undergoing cardiac surgery particularly those with comorbidities and frailty,experience frequently higher rates of post-operative morbidity,mortality and prolonged hospital length of stay.Muscle mass wasting seems to play important role in prolonged mechanical ventilation(MV)and consequently in intensive care unit(ICU)and hospital stay.AIM To investigate the clinical value of skeletal muscle mass assessed by ultrasound early after cardiac surgery in terms of duration of MV and ICU length of stay.METHODS In this observational study,we enrolled consecutively all patients,following their admission in the Cardiac Surgery ICU within 24 h of cardiac surgery.Bedside ultrasound scans,for the assessment of quadriceps muscle thickness,were performed at baseline and every 48 h for seven days or until ICU discharge.Muscle strength was also evaluated in parallel,using the Medical Research Council(MRC)scale.RESULTS Of the total 221 patients enrolled,ultrasound scans and muscle strength assessment were finally performed in 165 patients(patients excluded if ICU stay<24 h).The muscle thickness of rectus femoris(RF),was slightly decreased by 2.2%[(95%confidence interval(CI):-0.21 to 0.15),n=9;P=0.729]and the combined muscle thickness of the vastus intermedius(VI)and RF decreased by 3.5%[(95%CI:-0.4 to 0.22),n=9;P=0.530].Patients whose combined VI and RF muscle thickness was below the recorded median values(2.5 cm)on day 1(n=80),stayed longer in the ICU(47±74 h vs 28±45 h,P=0.02)and remained mechanically ventilated more(17±9 h vs 14±9 h,P=0.05).Moreover,patients with MRC score≤48 on day 3(n=7),required prolonged MV support compared to patients with MRC score≥49(n=33),(44±14 h vs 19±9 h,P=0.006)and had a longer duration of extracorporeal circulation was(159±91 min vs 112±71 min,P=0.025).CONCLUSION Skeletal quadriceps muscle thickness assessed by ultrasound shows a trend to a decrease in patients after cardiac surgery post-ICU admission and is associated with prolonged duration of MV and ICU length of stay.

Effect of Cardioplegia for Myocardial Protection in Pediatric Cardiac Surgery:A Network Meta-Analysis

Cardioplegia has been widely used to reduce myocardial injury during pediatric cardiac surgery;however,which cardioplegia solution has the best protective effect has not been established.Thus,we compared the myocardial protective effects of different cardioplegia solutions used in pediatric cardiac surgery.Seven databases were searched to identify the relevant randomized controlled trials.A network meta-analysis with a Bayesian framework was conducted.The outcomes included the following biochemical and clinical outcomes:serum concentrations of the creatine kinase-myocardial band at 6 h postoperatively;cardiac troponin I(cTnI)at 4,12,and 24 h postoperatively;spontaneous beating after declamping;postoperative arrhythmias;inotropic support percentage and duration;mechanical ventilation hours;intensive care unit stay in days;hospital stay in days;and mortality.The group treated with cold crystalloid cardioplegia(cCCP)was chosen as the control group.The 22 studies involved 1529 patients.Six types of cardioplegia solutions were described in these studies,including cold blood cardioplegia,cCCP,del Nido,histidine-tryptophan-ketoglutarate(HTK),terminal warm blood cardioplegia,and warm blood cardioplegia(wBCP).The serum concentrations of the 24-h cTnI with wBCP(MD=−2.52,95%CI:−4.74 to−0.27)was significantly lower than cCCP.The serum concentrations of the 24-h cTnI with HTK(MD=4.91,95%CI:2.84–7.24)was significantly higher than cCCP.There was no significant difference in other biochemical and clinical outcomes when compared to cCCP.In conclusion,wBCP may have a superior myocardial protective effect with lower 24-h cTnI levels postoperatively and similar clinical outcomes after pediatric cardiac surgery.

Replacement Therapy for Hemophilia Patients Undergoing Cardiac Surgery: Report of Three Cases

Hemophilia is an X-linked recessive inherited bleeding disorder.Despite the improved treatment in recent years with the advent of replacement therapies,the progression of atherosclerosis is not slowed down after the reduction of clotting factors in hemophilia.As life expectancy increases,more hemophilia patients will suffer from age-related cardiovascular diseases.Since cardiac surgery needs heparinization and cardiopulmonary bypass(CPB),it is extremely challenging to balance hemostasis and coagulation in patients with hemophilia.Here we report three cases of hemophilia patients who underwent cardiac surgery successfully.

Evaluation of 100 Cases of Mortality after Cardiac Surgery: A Single-Center Experience in Bangladesh

Background: Vigilance ensures safety in cardiac surgery. Performance in cardiac surgery is often measured by short-term mortality. Several risk factors like advanced age, female gender, higher body mass index, decreased left ventricular function, emergent, and redo operations have appeared recurrently as poor prognostic variables. Evaluation of postoperative mortality is crucial to find loopholes to provide proper care and reduce preventable mortality after cardiac surgery in developing countries with limited infrastructures and resources. Methods: This is a retrospective study conducted in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from the university medical record. The data on age, gender, body mass index, preoperative investigations, diagnoses, types of operations, details of cardiopulmonary bypass, and postoperative period of the study populations were evaluated. Results: During the study period, about 1627 cases of cardiac surgery were done with an overall mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0 - 68) years, and 66% of patients were male. Preoperative ejection fraction (EF) of the study population was an average 56.63% ± 11.85%;9% of the patients had EF < 40%. Off-pump coronary artery bypass (32.27%) was the most commonly performed surgery followed by mitral valve replacement (24.28%). On-pump cardiac surgery was done among 65% of the study population with a mean cross-clamp time and bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most of the mortality was found in the first two weeks after surgery. Conclusion: Mortality after cardiac surgery is multifactorial. A large-scale prospective study with comparative groups is required to find out preventable measures of mortality after cardiac surgery which will improve the quality of services provided to the patients in developing countries.

A Comparative Study on Safety and Efficacy of Caudal, Thoracic Epidural and Intra Venous Analgesia in Paediatric Cardiac Surgery: A Double Blind Randomised Trial

Introduction:Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are limited hence we aimed to compare efficacy and safety of caudal, thoracic epidural and intravenous analgesia in paediatric cardiac surgery. Methodology: This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if pain score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain scores were significantly lower in thoracic epidural group compared to other two grou ps. Duration of ventilation was lower in thoracic epidural group (91.17± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous analgesia groups (436.37 ± 705.51) minutes. Duration of ICU stay was significantly low in thoracic epidural group (2.73 ± 0.69) days compared to caudal (3.7 ± 2.8) and intravenous analgesia groups (4.33 ± 0.920). We didn’t have any complications like hematoma, transient or permanent neurological sequelae in regional anesthesia groups. Conclusion: Regional anaesthesia along with general anaesthesia was more effective in pain relief than intravenous analgesia with general anaesthesia in paediatric cardiac surgery.

Intraoperative vs 24-Hour Administration of Cefamandole to Prevent Deep Sternal Wound Infection and Endocarditis after Adult Cardiac Surgery

Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.

Postoperative jaundice after cardiac surgery

BACKGROUND:The frequency and pattern of hyperbili-rubinemia after open-heart surgery and its severe perioperative complications are not well clarified. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac operation,to analyze the determinants,and to identify the clinical significance of this complication with regard to the associated morbidity and mortality. METHODS:A prospective observational study was made during the period of 2003-2004 in a Surgical Intensive Care Unit of a Cardiac Surgery Center,Athens. One hundred twenty-eight adult patients for open heart surgery were divided into three groups. Group A included 50 patients who underwent coronary artery bypass crafting(CABG),group B 31 patients who were subjected to aortic valve replacement(AVR)+CABG and group C 47 patients who underwent mitral valve replacement(MVR)+CABG. Aminotransferases,alkaline phosphatase,gamma-glutamyl-transpeptidase and both types of bilirubin were determined at admission,24 hours after the operation and thereafter according to clinical evolution. The presence of jaundice was associated with elevated serum bilirubin above 3 mg/dl. RESULTS:Hyperbilirubinemia developed in 34 patients(26.5%). The incidence of postoperative jaundice was higher in patients who were subjected to MVR+CABG than to CABG and AVR+CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary by-passtime(P<0.001),aortic cross-clamping time(P<0.001),the use of intra aortic balloon pumping(P<0.001),the administration of inotrops and the number of blood and plasma transfusions. Postoperative jaundice resulted mainly from an increase in conjugated bilirubin. CONCLUSIONS:Although hyperbilirubinemia seems to be multifactorial,the type of operation,the preoperative hepatic dysfunction due to advanced heart failure(NYHA Ⅱ-Ⅲ) and the decreased hepatic flow during the operation seem to determine the incidence of jaundice.

Perfusionist strategies for blood conservation in pediatric cardiac surgery

There is increasing concern about the safety of homologous blood transfusion during cardiac surgery,and a restrictive transfusion practice is associated with improved outcome.Transfusion-free pediatric cardiac surgery is unrealistic for the vast majority of procedures in neonates or small infants;however,considerable progress has been made by using techniques that decrease the need for homologous blood products or even allow bloodless surgery in older infants and children.These techniques involve a decrease in prime volume by downsizing the bypass circuit with the help of vacuumassisted venous drainage,microplegia,autologous blood predonation with or without infusion of recombinant(erythropoietin),cell salvaging,ultrafiltration and retrograde autologous priming.The three major techniques which are simple,safe,efficient,and cost-effective are:a prime volume as small as possible,cardioplegia with negligible hydric balance and circuit residual blood salvaged without any alteration.Furthermore,these three techniques can be used for all the patients,including emergencies and small babies.In every pediatric surgical unit,a strategy to decrease or avoid blood bank transfusion must be implemented.A strategy to minimize transfusion requirement requires a combined effort involving the entire surgical team with pre-,peri-,and postoperative planning and management.

Heart rate variability： a new tool to predict complications in adult cardiac surgery

心率可变性(HRV ) 指在连续心跳之间的变化，它取决于自治神经系统的同情、副交感的分支的连续调整。HRV 被显示了作为在心肌的梗塞和糖尿病的神经病的早警告症状以后的风险的一个预言者有效，并且在心病学，背景是认出是为在医院承认以后并且在分泌物以后的风险层化的一个有用工具的现在。最近的证据建议 HRV 分析可能甚至在经历心脏的外科，和现在的评论的病人预言复杂并发症在当前的临床的实践为 HRV 使用在成年心脏的外科和观点总结 HRV 分析的重要性。尽管未来在 HRV 能在成年心脏的外科被包括进每日的临床的实践以前，更大的研究被保证， HRV 是可能在早手术后的阶段并且在医院停留期间检测自治不稳定性的一个新奇工具，因此预言或迅速诊断许多手术后的复杂并发症。

Randomized controlled trial of remote ischemic preconditioning and atrial fibrillation in patients undergoing cardiac surgery

AIM To study whether remote ischemic preconditioning(RIPC) has an impact on clinical outcomes, such as post-operative atrial fibrillation(POAF).METHODS This was a prospective, single-center, single-blinded,randomized controlled study. One hundred and two patients were randomized to receive RIPC(3 cycles of 5 min ischemia and 5 min reperfusion in the upper arm after induction of anesthesia) or no RIPC(control). Primary outcome was POAF lasting for five minutes or longer during the first seven days after surgery. Secondary outcomes included length of hospital stay, incidence of inpatient mortality, myocardial infarction, and stroke. RESULTS POAF occurred at a rate of 54% in the RIPC group and 41.2% in the control group(P = 0.23). No statistically significant differences were noted in secondary outcomes between the two groups. CONCLUSION This is the first study in the United States to suggest that RIPC does not reduce POAF in patients with elective or urgent cardiac surgery. There were no differences in adverse effects in either group. Further studies are required to assess the relationship between RIPC and POAF.

Stress gastric ulcer after cardiac surgery: Pathogenesis risk factors and medical management

Stress ulcer lesions of upper gastrointestinal tract are well recognized in patients undergoing open cardiac surgery. Gastrointestinal bleeding following cardiac surgery is infrequent with significant morbidity and mortality. The pathogenesis of mucosal lesions and subsequent haemorrhage is complex and multifactorial. The diagnosis as well as the treatment of this complication remains a challenge for surgeons. Identifying the source of bleeding can be difficult. Despite of the successful control of haemorrhage using various combinations of endoscopic and pharmacological therapies, the mortality rate remains unchanged. Benefit of routine stress ulcer prophylaxis remains controversial.

Mediastinitis in pediatric cardiac surgery:Prevention,diagnosis and treatment

In spite of advances in the management of mediastinitis following sternotomy,mediastinitis is still associated with significant morbidity.The prognosis is much better in pediatric surgery compared to adult surgery,but the prolonged hospital stays with intravenous therapy and frequent required dressing changes that occur with several therapeutic approaches are poorly tolerated.Prevention includes nasal decontamination,skin preparation,antibioprophylaxis and air filtration in the operating theater.The expertise of the surgical team is an additional factor that is difficult to assess precisely.Diagnosis is often very simple,being made on the basis of a septic state with wound modification,while retrosternal puncture and CT scan are rarely useful.Treatment of mediastinitis following sternotomy is always a combination of surgical debridement and antibiotic therapy.Continued use of numerous surgical techniques demonstrates that there is no consensus and the best treatment has yet to be determined.However,we suggest that a primary sternal closure is the best surgical option for pediatric patients.We propose a simple technique with high-vacuum Redon's catheter drainage that allows early mobilization and short term antibiotherapy,which thus decreases physiological and psychological trauma for patients and families.We have demonstrated the ef-ficiency of this technique,which is also cost-effective by decreasing intensive care and hospital stay durations,in a large group of patients.