Background:Advancements in diagnostic tools,surgical techniques,and long-termmanagement have significantly improved survival among individuals with congenital heart disease(CHD),leading to an evolving epidemiologic pr...Background:Advancements in diagnostic tools,surgical techniques,and long-termmanagement have significantly improved survival among individuals with congenital heart disease(CHD),leading to an evolving epidemiologic profile characterized by increasing procedural complexity and a growing adult CHD population.This study aimed to examine nationwide trends in CHD surgeries over a 17-year period,with a focus on temporal shifts in surgical volume,procedural complexity,and age-specific incidence.Methods:A total of 41,608 CHD surgeries and 85,417 surgical procedures performed between 2002 and 2018 were identified from a nationwide health insurance database.Temporal trends were evaluated using segmented linear regression,and age-specific standardized incidence rates were calculated per 100,000 population across three age groups:infants(<1 year),children(1-18 years),and adults(≥19 years).Results:Despite a decline in overall surgical volume(from 2523 in 2002 to 1624 in 2018),the number of surgical procedures rose markedly(from 2936 to 5402),indicating higher claims-based procedural volume per patient(i.e.,more billed procedure codes per operation),a proxy for operative intensity rather than a direct measure of clinical or system burden.This divergence was particularly notable in infants and adults,while pediatric surgical rates declined sharply.Age-specific incidence rates of surgical procedures showed a continuous rise in infants and a moderate increase in adults,whereas children demonstrated stable or declining trends.Breakpoints in temporal trends were identified in 2015 for surgeries and 2011 for procedures.Conclusions:The landscape of CHD surgery is undergoing a demographic and clinical transformation,with a shift toward early,complex operations in infants and reoperations in adults.These findings underscore the growing need for age-tailored,resource-intensive care models and long-term strategic planning to accommodate the evolving burden of CHD across the lifespan.展开更多
Objective: to investigate the risk factors and prevention methods of wound infection in emergency surgical trauma patients. Methods: a total of 150 patients admitted to our hospital from December 2018 to December 2019...Objective: to investigate the risk factors and prevention methods of wound infection in emergency surgical trauma patients. Methods: a total of 150 patients admitted to our hospital from December 2018 to December 2019 were selected as the research subjects. The above patients were all emergency surgical trauma patients. The above patients were divided into groups according to whether they had incision infection. Among them, 25 patients in the research group ( infection group) and 125 cases in the control group (uninfected group), the general data of the two groups of patients, the location of trauma, the use of antibiotics and other factors were statistically analyzed. Results: after treatment, among the 150 patients participating in the study, 25 patients had incision infection after surgery, and the infection rate was 16.7%. Factors include the location and number of trauma, the use of preoperative antibiotics, and age. The patient is older than 60 years old, has multiple trauma or head trauma, and has not been treated with anti-inflammatory drugs before surgery. The above factors are related to postoperative wound infection. There was a statistically significant difference between the factors (P0.05). Conclusion: in the treatment of trauma patients in emergency surgery, some patients will have incision infection. Evaluation and preventive measures for patients, and disinfection treatment in strict accordance with the standards can reduce the probability of incision infection and better improve the treatment effect. Promote and apply in emergency surgery.展开更多
Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 20...Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 2023)were screened and divided into two groups randomly.Each group consisted of 30 cases.The perioperative routine was used in the control group.The observation group underwent the perioperative routine along with better respiratory care.Oxygenation indicators,surgical complications,and family satisfaction levels of the groups were compared.Results:There was no significant difference in the oxygenation index between the two groups of children at admission(P>0.05).At discharge,the oxygenation indicators in the observation group were better than those of the control group,and the incidence of surgical complications was lower than that of the control group.The total satisfaction of family members in the observation group was higher than that of the control group(P<0.05).Conclusion:During the perioperative period for children with congenital heart disease,the implementation of respiratory care,which mainly involves symptomatic care,catheter care,sputum suction care,etc.,can actively improve the oxygenation indicators,reduce surgical complications,and promote faster and better recovery,of children with congenital heart disease.展开更多
BACKGROUND It is very important to provide effective nursing programs to regulate the physical and mental state of patients and to improve treatment compliance after interventional surgery for coronary heart disease(C...BACKGROUND It is very important to provide effective nursing programs to regulate the physical and mental state of patients and to improve treatment compliance after interventional surgery for coronary heart disease(CHD).AIM To explore the effect of a nursing intervention based on Maslow’s hierarchy of needs theory on patients with CHD undergoing percutaneous coronary intervention.METHODS Ninety-four patients with CHD undergoing interventional surgery in our hospital from January 2020 to February 2021 were randomly divided into a research group(n=47)and a control group(n=47).The control group received routine nursing,and the research group received a nursing intervention based on Maslow’s hierarchy of needs theory.The scores of self-efficacy,negative emotion[depression(SDS),anxiety(SAS)],intervention compliance(standardized medication,moderate exercise,healthy diet,and regular review),and nursing satisfaction were calculated before and after intervention for the two groups.RESULTS Before intervention,there was no significant difference in the scores of disease general management self-efficacy,disease management self-efficacy,and total self-efficacy between the two groups(P=0.795,0.479,and 0.659,respectively).After intervention,these three scores in the research group were higher than those in the control group(P<0.001).Before intervention,there was no significant difference in the scores of SAS and SDS between the two groups(P=0.149 and 0.347,respectively).After intervention,the scores of SAS and SDS in the research group were lower than those in the control group(P<0.001).The standardized drug use rate(97.87%),moderate exercise rate(97.87%),healthy diet rate(95.74%),and regular reexamination rate(97.87%)in the research group were higher than those in the control group(85.11%,82.98%,80.85%,and 87.23%,respectively)(P=0.027,0.014,0.025,and 0.049,respectively).Nursing job satisfaction in the research group(93.62%)was higher than that in the control group(78.72%)(P=0.036).CONCLUSION A nursing program based on Maslow’s hierarchy of needs theory can effectively alleviate negative emotion,enhance self-efficacy and intervention compliance,and ensure that the patients are highly satisfied with the nursing work.展开更多
Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods:...Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.展开更多
Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV ha...Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice. Although future larger studies are warranted before HRV can be included into daily clinical practice in adult cardiac surgery, HRV is a novel tool which might detect autonomic instability in the early postoperative phase and during hospital stay, thus predicting or prompt-diagnosing many of the post-operative complications.展开更多
Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-...Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Methods： Prospective randomized controlled trials（RCTs） that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. Pub Med, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. Results： We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable（relative risk（RR）=1.12, 95% confidence interval（CI）： 0.70 to 1.80, P=0.63）, but both were superior to the placebo（amiodarone, RR=0.71, 95% CI： 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI： 0.46 to 0.88, P=0.006）. The percentage of patients requiring electric defibrillation counter shocks（DCSs） did not differ significantly among patients administered amiodarone（RR=0.21, 95% CI： 0.04 to 1.19, P=0.08）, lidocaine（RR=2.44, 95% CI： 0.13 to 44.02, P=0.55）, or the placebo（RR=0.56, 95% CI： 0.25 to 1.25, P=0.16）. Conclusions： Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.展开更多
Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery （combined surgery） from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate l...Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery （combined surgery） from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identity risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent （50 %） were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age, weight, and preoperative hospital stay （days） were not found to be associated with prolonged mechanical ventilation. It was concluded that. for age and weight, this might be due to the lower number of old age patients （70 years and above） included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.展开更多
BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the curre...BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.展开更多
Selecting which explanatory variables to include in a given score is a common difficulty, as a balance must be found between statistical fit and practical application. This article presents a methodology for construct...Selecting which explanatory variables to include in a given score is a common difficulty, as a balance must be found between statistical fit and practical application. This article presents a methodology for constructing parsimonious event risk scores combining a stepwise selection of variables with ensemble scores obtained by aggregation of several scores, using several classifiers, bootstrap samples and various modalities of random selection of variables. Selection methods based on a probabilistic model can be used to achieve a stepwise selection for a given classifier such as logistic regression, but not directly for an ensemble classifier constructed by aggregation of several classifiers. Three selection methods are proposed in this framework, two involving a backward selection of the variables based on their coefficients in an ensemble score and the third involving a forward selection of the variables maximizing the AUC. The stepwise selection allows constructing a succession of scores, with the practitioner able to choose which score best fits his needs. These three methods are compared in an application to construct parsimonious short-term event risk scores in chronic HF patients, using as event the composite endpoint of death or hospitalization for worsening HF within 180 days of a visit. Focusing on the fastest method, four scores are constructed, yielding out-of-bag AUCs ranging from 0.81 (26 variables) to 0.76 (2 variables).展开更多
Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients...Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.展开更多
Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and peric...Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. Vacuum sealing drainage （VSD） is a new technology to promote wound healing. We studied the use of VSD technique in poor wound healing after heart valve surgery to see if it could achieve good therapeutic efficacy. Methods From 2013 October to 2014 October in Guang- dong General Hospital, 86 cases of the application of vacuum sealing drainage technique in the treatment of cardiac nonunion after valve replacement in patients with nursing observation. The treatment time, death rate and infection rate, etc were compared. Results Wound healing time of 86 patients receiving vacuum sealing drainage was 14.6 ± 3.6 days, and no patient died. Two patients came back to hospital for repair due to dehis- cence of the incision after discharge. Conclusion Nursing observation and drainage management were the key of VSD. VSD technique is worthy to be popularized clinically.展开更多
Pediatric and congenital heart disease(PCHD)affects millions of children worldwide,including over one million babies born with congenital heart disease(CHD)each year and 300,000 children dying from rheumatic heart dis...Pediatric and congenital heart disease(PCHD)affects millions of children worldwide,including over one million babies born with congenital heart disease(CHD)each year and 300,000 children dying from rheumatic heart disease(RHD)yearly.Although the vast majority of children born with CHD in high-income countries now reach adulthood and RHD is nearly eradicated in these countries,most of the world cannot access the necessary care to prevent or mitigate PCHD.In low-and middle-income countries,over 90%of children with PCHD cannot receive the care they need,as over 100 countries and territories lack local cardiac surgical capacity.The unmet needs for PCHD are large,albeit still poorly quantified,resulting in a considerable socioeconomic impact at the individual and societal levels.This review highlights the extensive opportunities to improve access to and scale PCHD care by strengthening research,clinical care delivery,capacity-building,advocacy,health policy,and financing.We discuss global disparities in access to congenital heart surgery,the socioeconomic impact of untreated PCHD,and propose strategies for scaling pediatric and congenital cardiac care.Our recommendations focus on enhancing research and data collection,expanding training programs,improving healthcare infrastructure,advocating for policy changes,leveraging technological innovations,fostering international collaborations,and developing comprehensive care models.展开更多
Background:The European Congenital Heart Surgeons Association(ECHSA)Congenital Heart Surgery Database(CHSD)was founded in 1999 and is open for worldwide participation.The current dataset includes a large amount of sur...Background:The European Congenital Heart Surgeons Association(ECHSA)Congenital Heart Surgery Database(CHSD)was founded in 1999 and is open for worldwide participation.The current dataset includes a large amount of surgical data from both Europe and China.The purpose of this analysis is to compare patterns of practice and outcomes among pediatric congenital heart defect surgeries in Europe and China using the ECHSA-CHSD.Methods:We examined all European(125 centers,58,261 operations)and Chinese(13 centers,23,920 operations)data in the ECHSA-CHSD from 2006-2018.Operative mortality,postoperative length of stay,median patient age and weight were calculated for the ten benchmark operations for China and Europe,respectively.Results:Benchmark procedure distribution frequencies differed between Europe and China.In China,ventricular septal defect repair comprised approximately 70%of procedures,while Norwood operations comprised less than one percent of all procedures.Neonatal cardiac procedures were rare in China overall.For procedures in STAT mortality category 1,Chinese centers had lower operative mortality rates,while procedures in categories 3 and 5 mortality is lower in European centers.Operative mortality over the time period decreased from 3.89%to 1.64%for the whole cohort,with a sharper decline in China.This drop coincides with an increase of submitted procedures over this 13-year-period.Conclusion:Chinese centers had higher programmatic volume of congenital heart surgeries,while European centers have a more complex case mix.Palliation for patients with functionally univentricular heart was performed less commonly in China.These comparison of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.展开更多
Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustai...Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.展开更多
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 wi...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.展开更多
The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertio...The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.展开更多
The development of the heart-lung machine made repair of intracardiac lesions possible. One of the key requirements of the heart-lung machine was anticoagulation. Heparin was discovered by a medical student, Jay McLea...The development of the heart-lung machine made repair of intracardiac lesions possible. One of the key requirements of the heart-lung machine was anticoagulation. Heparin was discovered by a medical student, Jay McLean, working in the laboratory of Dr. William Howell at Johns Hopkins. John Gibbon contributed more to the successful development of the heart-lung machine than anyone else. His interest began as a young doctor since 1930s. Gibbon＇s work on the heart-lung machine took place over the next 20 years in laboratories at Massachusetts General Hospital, the University of Pennsylvania, and Thomas Jefferson University In 1937, he reported the first successful demonstration that life could be maintained by an artificial heart and lung, and the native heart and lungs could resume fimction. After World War II, Dr. Gibbon resumed his work and received support from IBM to build a heart-lung machine on a more sophisticated scale. Eventually, the team developed a larger oxygenator that the IBM engineers incorporated into a new machine. On May 6, 1953, Dr. Gibbon performed the first successful operation using an extracorporeal circuit on an 18-year-old girl with a large atrial septal defect. It wasn＇t until 1958, when a system that involved bubbling blood was perfected, that ＂heart-lung＂ machines came of age. Despite so many chill winds and cold rains, ＂heart-lung＂ machine, the budding rose of surgery, was eventually blossom brightly in the radiant rays of sunlight. John Gibbon＇s dream had become a reality. His work serves as an important example to surgeons who are struggling today with the surgical therapies and technologies of tomorrow.展开更多
Background:Three-dimensional printing technology may become a key factor in transforming clinical practice and in significant improvement of treatment outcomes.The introduction of this technique into pediatric cardiac...Background:Three-dimensional printing technology may become a key factor in transforming clinical practice and in significant improvement of treatment outcomes.The introduction of this technique into pediatric cardiac surgery will allow us to study features of the anatomy and spatial relations of a defect and to simulate the optimal surgical repair on a printed model in every individual case.Methods:We performed the prospective cohort study which included 29 children with congenital heart defects.The hearts and the great vessels were modeled and printed out.Measurements of the same cardiac areas were taken in the same planes and points at multislice computed tomography images(group 1)and on printed 3D models of the hearts(group 2).Pre-printing treatment of the multislice computed tomography data and 3D model preparation were performed according to a newly developed algorithm.Results:The measurements taken on the 3D-printed cardiac models and the tomographic images did not differ significantly,which allowed us to conclude that the models were highly accurate and informative.The new algorithm greatly simplifies and speeds up the preparation of a 3D model for printing,while maintaining high accuracy and level of detail.Conclusions:The 3D-printed models provide an accurate preoperative assessment of the anatomy of a defect in each case.The new algorithm has several important advantages over other available programs.They enable the development of customized preliminary plans for surgical repair of each specific complex congenital heart disease,predict possible issues,determine the optimal surgical tactics,and significantly improve surgical outcomes.展开更多
Background:With the decline of birth population and the development of medical technology in China,studies assessing how these changes have affected the adoption of congenital heart disease surgery at the national or ...Background:With the decline of birth population and the development of medical technology in China,studies assessing how these changes have affected the adoption of congenital heart disease surgery at the national or regional scale are lacking.Methods:We investigated the status of congenital heart surgery in China in the period from 2017-2022,through investigation of the total rates of cardiac surgeries,cardiopulmonary bypass(CPB),adult congenital heart surgeries(CHS),and pediatric CHS(<18 years old),as recorded by the Extracorporeal Cir-culation Branch of the Chinese Society of Biomedical Engineering.Subsequently,we evaluated correlations between these factors with economic,demographic,and other factors.Results:From 2017 to 2022,the total num-ber of cardiac operations increased from 230,772 to 263,292,representing an increase of 14.09%over 6 years;the CHS dropped from 76,365 to 68,940(10.19%decrease),and the proportion of CHS in the total cardiac surgeries dropped from 33.26%to 26.18%(7.08%decrease).Finally,cases of pediatric CHS decreased from 61,825 to 38,174(38.25%decrease).The annual percentage change(APC)of the total amount of pediatric CHS cases was-10.03(-15.95 to-3.69,p=0.013).Adult CHS increased from 14,940 to 30,766(105.93%increase).The proportion of adult CHS cases of the total number of cardiac surgeries increased from 6.47%to 11.68%(5.21%increase).From a regional perspective,the APC for the proportion of pediatric CHS in the local population was generally lower in western China.The proportion of CHS in the local population generally decreases from the north to the south,although the lowest incidence is found in the northeast region.Conclusions:Due to demographic changes,med-ical technology and economic factors,the number of surgical operations for congenital heart disease(CHD)in children decreased significantly from 2017 to 2022,and may decline further in the future.Nevertheless,in the same period,a significant increase in the number of operations for CHD in adults was observed,which brings new opportunities and challenges to the development of congenital cardiac surgery and cardiac critical care.展开更多
文摘Background:Advancements in diagnostic tools,surgical techniques,and long-termmanagement have significantly improved survival among individuals with congenital heart disease(CHD),leading to an evolving epidemiologic profile characterized by increasing procedural complexity and a growing adult CHD population.This study aimed to examine nationwide trends in CHD surgeries over a 17-year period,with a focus on temporal shifts in surgical volume,procedural complexity,and age-specific incidence.Methods:A total of 41,608 CHD surgeries and 85,417 surgical procedures performed between 2002 and 2018 were identified from a nationwide health insurance database.Temporal trends were evaluated using segmented linear regression,and age-specific standardized incidence rates were calculated per 100,000 population across three age groups:infants(<1 year),children(1-18 years),and adults(≥19 years).Results:Despite a decline in overall surgical volume(from 2523 in 2002 to 1624 in 2018),the number of surgical procedures rose markedly(from 2936 to 5402),indicating higher claims-based procedural volume per patient(i.e.,more billed procedure codes per operation),a proxy for operative intensity rather than a direct measure of clinical or system burden.This divergence was particularly notable in infants and adults,while pediatric surgical rates declined sharply.Age-specific incidence rates of surgical procedures showed a continuous rise in infants and a moderate increase in adults,whereas children demonstrated stable or declining trends.Breakpoints in temporal trends were identified in 2015 for surgeries and 2011 for procedures.Conclusions:The landscape of CHD surgery is undergoing a demographic and clinical transformation,with a shift toward early,complex operations in infants and reoperations in adults.These findings underscore the growing need for age-tailored,resource-intensive care models and long-term strategic planning to accommodate the evolving burden of CHD across the lifespan.
文摘Objective: to investigate the risk factors and prevention methods of wound infection in emergency surgical trauma patients. Methods: a total of 150 patients admitted to our hospital from December 2018 to December 2019 were selected as the research subjects. The above patients were all emergency surgical trauma patients. The above patients were divided into groups according to whether they had incision infection. Among them, 25 patients in the research group ( infection group) and 125 cases in the control group (uninfected group), the general data of the two groups of patients, the location of trauma, the use of antibiotics and other factors were statistically analyzed. Results: after treatment, among the 150 patients participating in the study, 25 patients had incision infection after surgery, and the infection rate was 16.7%. Factors include the location and number of trauma, the use of preoperative antibiotics, and age. The patient is older than 60 years old, has multiple trauma or head trauma, and has not been treated with anti-inflammatory drugs before surgery. The above factors are related to postoperative wound infection. There was a statistically significant difference between the factors (P0.05). Conclusion: in the treatment of trauma patients in emergency surgery, some patients will have incision infection. Evaluation and preventive measures for patients, and disinfection treatment in strict accordance with the standards can reduce the probability of incision infection and better improve the treatment effect. Promote and apply in emergency surgery.
文摘Objective:To analyze the perioperative respiratory care methods and application value in children with congenital heart disease.Methods:60 children with congenital heart disease(treated from January 2021 to October 2023)were screened and divided into two groups randomly.Each group consisted of 30 cases.The perioperative routine was used in the control group.The observation group underwent the perioperative routine along with better respiratory care.Oxygenation indicators,surgical complications,and family satisfaction levels of the groups were compared.Results:There was no significant difference in the oxygenation index between the two groups of children at admission(P>0.05).At discharge,the oxygenation indicators in the observation group were better than those of the control group,and the incidence of surgical complications was lower than that of the control group.The total satisfaction of family members in the observation group was higher than that of the control group(P<0.05).Conclusion:During the perioperative period for children with congenital heart disease,the implementation of respiratory care,which mainly involves symptomatic care,catheter care,sputum suction care,etc.,can actively improve the oxygenation indicators,reduce surgical complications,and promote faster and better recovery,of children with congenital heart disease.
文摘BACKGROUND It is very important to provide effective nursing programs to regulate the physical and mental state of patients and to improve treatment compliance after interventional surgery for coronary heart disease(CHD).AIM To explore the effect of a nursing intervention based on Maslow’s hierarchy of needs theory on patients with CHD undergoing percutaneous coronary intervention.METHODS Ninety-four patients with CHD undergoing interventional surgery in our hospital from January 2020 to February 2021 were randomly divided into a research group(n=47)and a control group(n=47).The control group received routine nursing,and the research group received a nursing intervention based on Maslow’s hierarchy of needs theory.The scores of self-efficacy,negative emotion[depression(SDS),anxiety(SAS)],intervention compliance(standardized medication,moderate exercise,healthy diet,and regular review),and nursing satisfaction were calculated before and after intervention for the two groups.RESULTS Before intervention,there was no significant difference in the scores of disease general management self-efficacy,disease management self-efficacy,and total self-efficacy between the two groups(P=0.795,0.479,and 0.659,respectively).After intervention,these three scores in the research group were higher than those in the control group(P<0.001).Before intervention,there was no significant difference in the scores of SAS and SDS between the two groups(P=0.149 and 0.347,respectively).After intervention,the scores of SAS and SDS in the research group were lower than those in the control group(P<0.001).The standardized drug use rate(97.87%),moderate exercise rate(97.87%),healthy diet rate(95.74%),and regular reexamination rate(97.87%)in the research group were higher than those in the control group(85.11%,82.98%,80.85%,and 87.23%,respectively)(P=0.027,0.014,0.025,and 0.049,respectively).Nursing job satisfaction in the research group(93.62%)was higher than that in the control group(78.72%)(P=0.036).CONCLUSION A nursing program based on Maslow’s hierarchy of needs theory can effectively alleviate negative emotion,enhance self-efficacy and intervention compliance,and ensure that the patients are highly satisfied with the nursing work.
基金supported by college medical journal clinicalspecial funds(11321587)
文摘Objective: To compare the clinical outcomes of minimally invasive right subaxillary vertical thoracotomy and traditional median stemotomy through right atrium in treatment of common congenital heart diseases. Methods: Clinical data of 59 cases of common congenital heart diseases treated with minimally invasive right axillary vertical thoracotomy from May, 2011 to February, 2013 and 77 cases of same diseases with traditional median stemotomy in the past three years were retrospectively analyzed, including atrial septal defect, membranous ventricular septal defect and partial endocardial cushion defect. The results were compared from the two groups, including the time for operation and cardiopulmonary bypass, amount of blood transfusion, postoperative drainage, ventilation time, hospital stay, and prognosis. Results: No severe complications happened in both groups, like deaths or secondary surgery caused by bleeding. No significant differences were in CPB time and postoperative ventilator time between groups (P>0.05), while for all of the operative time, the length of incision, postoperative drainage and hospital stay, minimally invasive right axillary vertical thoracotomy was superior to median stemotomy, with statistically significant differences (P<0.05). In six month followup after operation, no complications of residual deformity and pericardial effusion were found in both groups by doing echocardiography, but mild pectus carinatum was found in 8 patients in the traditional median sternotomy group (traditional group), whereas patients in another group were well recovered. Conclusions: Minimally invasive right subaxillary vertical thoracotomy for common congenital heart diseases is as safe as traditional median stemotomy, without the increasing incidence of postoperative complications. Additionally, compared with traditional median stemotomy, minimally - invasive right subaxillary vertical thoracotomy is better in the aspects of hidden incision, appearance, and postoperative recovery.
文摘Heart rate variability （HRV） refers to the variations between consecutive heartbeats, which depend on the continuous modulation of the sympathetic and parasympathetic branches of the autonomic nervous system. HRV has been shown to be effective as a predictor of risk after myocardial infarction and an early warning sign of diabetic neuropathy, and in the cardiology setting is now recognized to be a useful tool for risk-stratification after hospital admission and after discharge. Recent evidences suggest that HRV analysis might predict complications even in patients undergoing cardiac surgery, and the present review summarizes the importance of HRV analysis in adult cardiac surgery and the perspectives for HRV use in current clinical practice. Although future larger studies are warranted before HRV can be included into daily clinical practice in adult cardiac surgery, HRV is a novel tool which might detect autonomic instability in the early postoperative phase and during hospital stay, thus predicting or prompt-diagnosing many of the post-operative complications.
文摘Objective： The relative preventative efficacy of amiodarone and lidocaine for ventricular fibrillation（VF） after release of an aortic cross-clamp（ACC） during open heart surgery has not been determined. This meta-analysis was designed to systematically evaluate the influence of amiodarone, lidocaine, or placebo on the incidence of VF after ACC. Methods： Prospective randomized controlled trials（RCTs） that compared the VF-preventative effects of amiodarone with lidocaine, or amiodarone or lidocaine with placebo were included. Pub Med, EMBASE, and the Cochrane Library were searched for relevant RCTs. Fixed or randomized effect models were applied according to the heterogeneity of the data from the selected studies. Results： We included eight RCTs in the analysis. Pooled results suggested that the preventative effects of amiodarone and lidocaine were comparable（relative risk（RR）=1.12, 95% confidence interval（CI）： 0.70 to 1.80, P=0.63）, but both were superior to the placebo（amiodarone, RR=0.71, 95% CI： 0.51 to 1.00, P=0.05; lidocaine, RR=0.63, 95% CI： 0.46 to 0.88, P=0.006）. The percentage of patients requiring electric defibrillation counter shocks（DCSs） did not differ significantly among patients administered amiodarone（RR=0.21, 95% CI： 0.04 to 1.19, P=0.08）, lidocaine（RR=2.44, 95% CI： 0.13 to 44.02, P=0.55）, or the placebo（RR=0.56, 95% CI： 0.25 to 1.25, P=0.16）. Conclusions： Amiodarone and lidocaine are comparably effective in preventing VF after ACC, but the percentage of patients who subsequently require DCSs does not differ among those administered amiodarone, lidocaine, or placebo.
文摘Data from 736 patients undergoing prosthetic heart valve replacement surgery and concomitant surgery （combined surgery） from January 1998 to January 2004 at Union Hospital were retrospectively reviewed. Univariate logistic regression analyses were conducted to identity risk factors for prolonged mechanical ventilation. The results showed that prolonged cardiopulmonary bypass duration, prolonged aortic cross clamp time and low ejection fraction less than 50 percent （50 %） were found to be independent predictors for prolonged mechanical ventilation. Meanwhile age, weight, and preoperative hospital stay （days） were not found to be associated with prolonged mechanical ventilation. It was concluded that. for age and weight, this might be due to the lower number of old age patients （70 years and above） included in our study and genetic body structure of majority Chinese population that favor them to be in normal weight, respectively.
基金National Natural Science Foundation of China,No.81860519.
文摘BACKGROUND Robotic resection using the natural orifice specimen extraction surgery I-type F method(R-NOSES I-F)is a novel minimally invasive surgical strategy for the treatment of lower rectal cancer.However,the current literature on this method is limited to case reports,and further investigation into its safety and feasibility is warranted.AIM To evaluate the safety and feasibility of R-NOSES I-F for the treatment of low rectal cancer.METHODS From September 2018 to February 2022,206 patients diagnosed with low rectal cancer at First Affiliated Hospital of Nanchang University were included in this retrospective analysis.Of these patients,22 underwent R-NOSES I-F surgery(RNOSES I-F group)and 76 underwent conventional robotic-assisted low rectal cancer resection(RLRC group).Clinicopathological data of all patients were collected and analyzed.Postoperative outcomes and prognoses were compared between the two groups.Statistical analysis was performed using SPSS software.RESULTS Patients in the R-NOSES I-F group had a significantly lower visual analog score for pain on postoperative day 1(1.7±0.7 vs 2.2±0.6,P=0.003)and shorter postoperative anal venting time(2.7±0.6 vs 3.5±0.7,P<0.001)than those in the RLRC group.There were no significant differences between the two groups in terms of sex,age,body mass index,tumor size,TNM stage,operative time,intrao-perative bleeding,postoperative complications,or inflammatory response(P>0.05).Postoperative anal and urinary functions,as assessed by Wexner,low anterior resection syndrome,and International Prostate Symptom Scale scores,were similar in both groups(P>0.05).Long-term follow-up revealed no significant differences in the rates of local recurrence and distant metastasis between the two groups(P>0.05).CONCLUSION R-NOSES I-F is a safe and effective minimally invasive procedure for the treatment of lower rectal cancer.It improves pain relief,promotes gastrointestinal function recovery,and helps avoid incision-related complications.
文摘Selecting which explanatory variables to include in a given score is a common difficulty, as a balance must be found between statistical fit and practical application. This article presents a methodology for constructing parsimonious event risk scores combining a stepwise selection of variables with ensemble scores obtained by aggregation of several scores, using several classifiers, bootstrap samples and various modalities of random selection of variables. Selection methods based on a probabilistic model can be used to achieve a stepwise selection for a given classifier such as logistic regression, but not directly for an ensemble classifier constructed by aggregation of several classifiers. Three selection methods are proposed in this framework, two involving a backward selection of the variables based on their coefficients in an ensemble score and the third involving a forward selection of the variables maximizing the AUC. The stepwise selection allows constructing a succession of scores, with the practitioner able to choose which score best fits his needs. These three methods are compared in an application to construct parsimonious short-term event risk scores in chronic HF patients, using as event the composite endpoint of death or hospitalization for worsening HF within 180 days of a visit. Focusing on the fastest method, four scores are constructed, yielding out-of-bag AUCs ranging from 0.81 (26 variables) to 0.76 (2 variables).
基金supported by National Key Technology Research and Development Program(No.2011BAI11B22)Medical Scientific Research Foundation of Guangdong Province(No.B2012002)Guangdong Population and Family Planning Foundation(No.2012264)
文摘Background Atrial fibrillation（AF） is the most common arrhythmia in patients with rheumatic heart disease（RHD）. The impact of prophylactic oral amiodarone and total dosage on postoperative outcomes in RHD patients accompanied by AF after cardiac valve surgery（CVS） is still unknown. Methods This retrospective analysis was performed on a total of 562 RHD patients with preoperative permanent AF undergoing CVS. One hundred and thirty-five patients receiving preoperative oral amiodarone were in the amiodarone group, 427 patients with no exposure to amiodarone were in the control group. Data gathered included constitution of the surgical approaches, postoperative incidence of conversion from AF to sinus rhythm, low cardiac output, rapid AF and ventricular arrhythmias, mechanical ventilation time, length of ICU stay, length of hospital stay, and average ventricular rates in patients with AF at discharge. Results In the amiodarone group, 30 patients converted to sinus rhythm after surgery, the incidence（30/135, 22.2%） was higher than that in the control group（45/427, 10.5%, P 〈 0.05）. Compared with patients in the control group,incidence of rapid AF（19.3% vs 27.4%） and ventricular arrhythmias（6.7% vs 12.1%） in the amiodarone group were significantly lower（P 〈 0.05）. Length of ICU stay and hospital stay in the amiodarone group were significantly shorter than those in the control group（P 〈 0.05）. The sinus rhythm conversion rate of the patients with total dosage of above 10 g（14/43, 32.6%） was significantly higher than that of the patients receiving less than 10 g（16/92, 17.4%） amiodarone（P 〈 0.05）. Conclusions Prophylactic oral amiodarone increases postoperative sinus rhythm conversion rate in RHD patients with preoperative permanent AF after CVS, and shows a dose-response relationship with the conversion rate. It also reduces the incidences of tachyarrhythmia and ventricular arrhythmias, shortens ICU stay and hospital stay, thus improving the prognosis of those patients.
基金supported by Medical Scientific Research Foundation of Guangdong Province(No.B2013019)National Science & Technology Pillar Program during the 12th Five-year Plan Period(No.2013BAI07B00)
文摘Background Poor wound healing or postoperative infection after open-heart surgery is most commonly seen. If not treated in time or the infection progresses, it can lead to sternal infection, even mediastinal and pericardial infection, causing a higher mortality rate. Vacuum sealing drainage （VSD） is a new technology to promote wound healing. We studied the use of VSD technique in poor wound healing after heart valve surgery to see if it could achieve good therapeutic efficacy. Methods From 2013 October to 2014 October in Guang- dong General Hospital, 86 cases of the application of vacuum sealing drainage technique in the treatment of cardiac nonunion after valve replacement in patients with nursing observation. The treatment time, death rate and infection rate, etc were compared. Results Wound healing time of 86 patients receiving vacuum sealing drainage was 14.6 ± 3.6 days, and no patient died. Two patients came back to hospital for repair due to dehis- cence of the incision after discharge. Conclusion Nursing observation and drainage management were the key of VSD. VSD technique is worthy to be popularized clinically.
文摘Pediatric and congenital heart disease(PCHD)affects millions of children worldwide,including over one million babies born with congenital heart disease(CHD)each year and 300,000 children dying from rheumatic heart disease(RHD)yearly.Although the vast majority of children born with CHD in high-income countries now reach adulthood and RHD is nearly eradicated in these countries,most of the world cannot access the necessary care to prevent or mitigate PCHD.In low-and middle-income countries,over 90%of children with PCHD cannot receive the care they need,as over 100 countries and territories lack local cardiac surgical capacity.The unmet needs for PCHD are large,albeit still poorly quantified,resulting in a considerable socioeconomic impact at the individual and societal levels.This review highlights the extensive opportunities to improve access to and scale PCHD care by strengthening research,clinical care delivery,capacity-building,advocacy,health policy,and financing.We discuss global disparities in access to congenital heart surgery,the socioeconomic impact of untreated PCHD,and propose strategies for scaling pediatric and congenital cardiac care.Our recommendations focus on enhancing research and data collection,expanding training programs,improving healthcare infrastructure,advocating for policy changes,leveraging technological innovations,fostering international collaborations,and developing comprehensive care models.
文摘Background:The European Congenital Heart Surgeons Association(ECHSA)Congenital Heart Surgery Database(CHSD)was founded in 1999 and is open for worldwide participation.The current dataset includes a large amount of surgical data from both Europe and China.The purpose of this analysis is to compare patterns of practice and outcomes among pediatric congenital heart defect surgeries in Europe and China using the ECHSA-CHSD.Methods:We examined all European(125 centers,58,261 operations)and Chinese(13 centers,23,920 operations)data in the ECHSA-CHSD from 2006-2018.Operative mortality,postoperative length of stay,median patient age and weight were calculated for the ten benchmark operations for China and Europe,respectively.Results:Benchmark procedure distribution frequencies differed between Europe and China.In China,ventricular septal defect repair comprised approximately 70%of procedures,while Norwood operations comprised less than one percent of all procedures.Neonatal cardiac procedures were rare in China overall.For procedures in STAT mortality category 1,Chinese centers had lower operative mortality rates,while procedures in categories 3 and 5 mortality is lower in European centers.Operative mortality over the time period decreased from 3.89%to 1.64%for the whole cohort,with a sharper decline in China.This drop coincides with an increase of submitted procedures over this 13-year-period.Conclusion:Chinese centers had higher programmatic volume of congenital heart surgeries,while European centers have a more complex case mix.Palliation for patients with functionally univentricular heart was performed less commonly in China.These comparison of patterns of practice and outcomes demonstrate opportunities for continuing bidirectional transcontinental collaboration and quality improvement.
文摘Background: The majority of prospective cardiac surgical patients in sub Saharan Africa lack access to open heart surgery. We reviewed our midterm results to identify the obstacles to growth and challenges with sustainability. Methods: Records of patients undergoing heart surgery at LASUTH from December 2004 to March 2006 were retrospectively reviewed for clinical and outcome data. Results: Twenty four patients age 10-50, mean 28.0 +/? 10.49 years and 13 (54.2%) males underwent surgery. 12 (50.0%) patients had mechanical valve replacements, 11 (45.8%) closure of septal defects and 1 (4.2%) left atrial myxoma resection. Logistic euroscore for valve patients was 5.81 +/? 4.74 while observed mortality was 8.3% (1/12). Overall 30 days operative mortality was 8.3% (2/24) and major morbidity 4.2% (1/24). Patients with septal defects closure stopped clinic visits within a year. Valve patients follow up was complete in 90.1% with mean duration of 55.2 +/? 15.3 months. Late events occurred only in females with mitral valve replacements. The 5-year freedom from thromboembolism and bleeding was 74.0% and survival 82.0% in valve patients. Conclusion: Despite limited resources heart surgery can safely be performed with good outcomes by trained local personnel under supervision of visiting foreign teams until they are proficient to operate independently. Patients with less complex congenital defects have excellent postsurgical outcomes, while patients with rheumatic valve replacement are subject to ongoing valve related morbidity and mortality therefore require lifetime follow up. Choice of prosthetic valve for the mostly indigent and poorly educated population remains a challenge. We now prefer stented tissue valve despite its known limitations, in child bearing age females desirous of childbirth and others unlikely to comply with anticoagulation regimen. Barriers to sustainability include poor infrastructures, few skilled manpower, inadequate funding and restricted patient access due to inability to pay without third party insurance or government Medicaid.
文摘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.
文摘The appropriate preparation of the patient with asymptomatic congenital complete heart block (CCHB) and a narrow QRS complex for elective non-cardiac surgery is controversial. Prophylactic temporary pacemaker insertion is associated with well-defined risks, and less invasive techniques exist to treat transient, hemodynamically significant intraoperative brady-arrhythmias. The present case report details the performance of general anesthesia for arthroscopic knee surgery in an adult patient with this condition without a pacemaker. Documentation of preoperative chronotropic competence with isoproterenol may be of value in deciding whether to proceed without temporary pacing capability in this setting.
文摘The development of the heart-lung machine made repair of intracardiac lesions possible. One of the key requirements of the heart-lung machine was anticoagulation. Heparin was discovered by a medical student, Jay McLean, working in the laboratory of Dr. William Howell at Johns Hopkins. John Gibbon contributed more to the successful development of the heart-lung machine than anyone else. His interest began as a young doctor since 1930s. Gibbon＇s work on the heart-lung machine took place over the next 20 years in laboratories at Massachusetts General Hospital, the University of Pennsylvania, and Thomas Jefferson University In 1937, he reported the first successful demonstration that life could be maintained by an artificial heart and lung, and the native heart and lungs could resume fimction. After World War II, Dr. Gibbon resumed his work and received support from IBM to build a heart-lung machine on a more sophisticated scale. Eventually, the team developed a larger oxygenator that the IBM engineers incorporated into a new machine. On May 6, 1953, Dr. Gibbon performed the first successful operation using an extracorporeal circuit on an 18-year-old girl with a large atrial septal defect. It wasn＇t until 1958, when a system that involved bubbling blood was perfected, that ＂heart-lung＂ machines came of age. Despite so many chill winds and cold rains, ＂heart-lung＂ machine, the budding rose of surgery, was eventually blossom brightly in the radiant rays of sunlight. John Gibbon＇s dream had become a reality. His work serves as an important example to surgeons who are struggling today with the surgical therapies and technologies of tomorrow.
基金funded by the Ministry of Science and Higher Education of the Russian Federation as part of the World-Class Research Center Program:Advanced Digital Technologies(Contract No.075-15-2022-311,dated 20.04.2022).
文摘Background:Three-dimensional printing technology may become a key factor in transforming clinical practice and in significant improvement of treatment outcomes.The introduction of this technique into pediatric cardiac surgery will allow us to study features of the anatomy and spatial relations of a defect and to simulate the optimal surgical repair on a printed model in every individual case.Methods:We performed the prospective cohort study which included 29 children with congenital heart defects.The hearts and the great vessels were modeled and printed out.Measurements of the same cardiac areas were taken in the same planes and points at multislice computed tomography images(group 1)and on printed 3D models of the hearts(group 2).Pre-printing treatment of the multislice computed tomography data and 3D model preparation were performed according to a newly developed algorithm.Results:The measurements taken on the 3D-printed cardiac models and the tomographic images did not differ significantly,which allowed us to conclude that the models were highly accurate and informative.The new algorithm greatly simplifies and speeds up the preparation of a 3D model for printing,while maintaining high accuracy and level of detail.Conclusions:The 3D-printed models provide an accurate preoperative assessment of the anatomy of a defect in each case.The new algorithm has several important advantages over other available programs.They enable the development of customized preliminary plans for surgical repair of each specific complex congenital heart disease,predict possible issues,determine the optimal surgical tactics,and significantly improve surgical outcomes.
文摘Background:With the decline of birth population and the development of medical technology in China,studies assessing how these changes have affected the adoption of congenital heart disease surgery at the national or regional scale are lacking.Methods:We investigated the status of congenital heart surgery in China in the period from 2017-2022,through investigation of the total rates of cardiac surgeries,cardiopulmonary bypass(CPB),adult congenital heart surgeries(CHS),and pediatric CHS(<18 years old),as recorded by the Extracorporeal Cir-culation Branch of the Chinese Society of Biomedical Engineering.Subsequently,we evaluated correlations between these factors with economic,demographic,and other factors.Results:From 2017 to 2022,the total num-ber of cardiac operations increased from 230,772 to 263,292,representing an increase of 14.09%over 6 years;the CHS dropped from 76,365 to 68,940(10.19%decrease),and the proportion of CHS in the total cardiac surgeries dropped from 33.26%to 26.18%(7.08%decrease).Finally,cases of pediatric CHS decreased from 61,825 to 38,174(38.25%decrease).The annual percentage change(APC)of the total amount of pediatric CHS cases was-10.03(-15.95 to-3.69,p=0.013).Adult CHS increased from 14,940 to 30,766(105.93%increase).The proportion of adult CHS cases of the total number of cardiac surgeries increased from 6.47%to 11.68%(5.21%increase).From a regional perspective,the APC for the proportion of pediatric CHS in the local population was generally lower in western China.The proportion of CHS in the local population generally decreases from the north to the south,although the lowest incidence is found in the northeast region.Conclusions:Due to demographic changes,med-ical technology and economic factors,the number of surgical operations for congenital heart disease(CHD)in children decreased significantly from 2017 to 2022,and may decline further in the future.Nevertheless,in the same period,a significant increase in the number of operations for CHD in adults was observed,which brings new opportunities and challenges to the development of congenital cardiac surgery and cardiac critical care.
