Q84281456
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Syndrom křehkosti je klinický syndrom, ve kterém jsou přítomny tři nebo více z následujících kritérií: neúmyslný úbytek hmotnosti 4,5 kg (10 liber) za poslední rok, pacientem udávaná vyčerpanost, slabá svalová síla úchopu, pomalá rychlost chůze a snížená fyzická aktivita. Prevalence křehkosti u kardiochirurgických pacientů je podle dostupných studií od 4,1 % do 46 %. Je spojený s výskytem sarkopenie a osteoporózy. Pro diagnostiku v kardiochirurgii je vhodný nástroj Edmonton Frail Scale, který je vyvinut pro negeriatrické specialisty a poskytuje informace ohledně závislosti pacienta na okolí, znalost zvládání běžných denních aktivit a úrovně fyzické zdatnosti. Existuje široká škála dalších nástrojů k hodnocení. Syndrom křehkosti je nezávislý rizikový faktor zvýšené morbidity, mortality a prodloužené doby hospitalizace po kardiochirurgické operaci. Tito pacienti mají vysoké riziko neúspěchu zvoleného terapeutického postupu. Základem péče o rizikové pacienty je screening a prevence vzniku syndromu křehkosti. Dá se mu předejít dostatečnou fyzickou aktivitou, zdravým životním stylem a pravidelným kognitivním tréninkem.
Frailty syndrome is a clinical syndrome in which three or more of the following criteria are present: an unintentional weight loss of 4.5 kg (10 lb) in the past year, patient-reported exhaustion, poor muscle grip strength, slow walking speed, and reduced physical activity. The prevalence of frailty in cardiac surgery patients ranges from 4.1% to 46% according to available studies. It is associated with the occurrence of sarcopenia and osteoporosis. The Edmonton Frail Scale tool, developed for non-geriatric specialists, is useful for diagnosis in cardiac surgery and provides information regarding the patient's dependence on the environment, knowledge of coping with normal daily activities and level of physical fitness. A wide range of other assessment tools are available. Frailty syndrome is an independent risk factor for increased morbidity, mortality, and prolonged hospital stay after cardiac surgery. These patients have a high risk of failure of the chosen therapeutic approach. Screening and prevention of frailty syndrome is the cornerstone of care for patients at risk. It can be prevented by sufficient physical activity, a healthy lifestyle, and regular cognitive training. Klíčová slova: Kardiochirurgie Prehabilitace Rehabilitace Sarkopenie Syndrom křehkosti Keywords: Cardiac surgery Frailty syndrome Prehabilitation Rehabilitation Sarcopenia
INTRODUCTION: The effect of bone wax on sternal infection and intraoperative bleeding in off-pump coronary surgery has not been reported in current literature. AIM: To prospectively evalute this in a cohort of high risk patients undergoing off-pump coronary artery surgery at our institution. The potential impact on cell saver utilization was also studied. MATERIAL AND METHODS: A prospective randomized study was performed in 58 diabetic patients operated on for two-vessel coronary artery disease by the off-pump technique. They were randomly assigned to the wax or no-wax group. RESULTS: There was no significant difference in intraoperative blood loss between the wax (550 ml) and no-wax group (750 ml; p = 0.0711). In multivariate analysis the absence (non-use) of bone wax (odds ratio = 3.9 (1.12-13.51), p = 0.027) and preoperative creatinin level (odds ratio = 1.1 (0.99-1.03), p = 0.03) were identified as independent predictors of blood loss ≥ 750 ml. The number of red blood cell units during hospital stay was similar in both groups (p = 0.42). Wound healing complications were not observed in either group. CONCLUSIONS: The use of bone wax does not lead to a higher risk of sternal wound infection. It may reduce the risk of high intraoperative blood loss, thus avoiding the need of a cell saver during off-pump coronary surgery. However, this influence remains questionable.
- Publikační typ
- časopisecké články MeSH
Introduction: Primary cardiac tumors are a rare condition presenting with a variety of symptoms. The outcomes of their surgical treatment in the modern era from central Europe have not been recently reported. Aim: To evaluate the short- and long-term outcomes of the cardiac tumor operations at our department throughout the last 20 years. Material and methods: This was a retrospective analysis of all primary cardiac tumor operations performed at our institution between 2000 and 2020. Perioperative data were extracted from patient records. Long-term data were provided by the National Registry of Cardiac Surgery. Results: Sixty procedures for primary cardiac tumor were performed throughout the study period. The most common type of tumor was myxoma (88%), followed by fibroelastoma (8%), lipoma (2%) and sarcoma (2%). There were 2 perioperative deaths (3%). The most common perioperative complication was atrial fibrillation (47%). One (2%) patient underwent reoperation 6 years later because of myxoma recurrence. We recorded 13 long-term deaths, but only 1 patient died as a consequence of cardiac tumor (sarcoma) 15 months after the surgery. Long-term survival of the cohort was comparable with the age- and sex-matched general population up to 15 years postoperatively (relative survival 0.91, CI 0.68-1.23). Rich histopathological illustrations are provided in the online supplementary material. Conclusions: Surgical resection is the standard treatment of primary cardiac tumors. The outcomes of benign tumors are excellent and the long-term postoperative survival is comparable with the general population. The prognosis of malignant tumors remains poor.
- Publikační typ
- časopisecké články MeSH
OBJECTIVES: Conventional mitral valve surgery through median sternotomy improves long-term survival with acceptable morbidity and mortality. However, less-invasive approaches to mitral valve surgery are now increasingly employed. Whether minimally invasive mitral valve surgery is superior to conventional surgery is uncertain. METHODS: A retrospective analysis of patients who underwent mitral valve surgery via minithoracotomy or median sternotomy between 2012 and 2018. A propensity score-matched analysis was generated to eliminate differences in relevant preoperative risk factors between the two groups. RESULTS: Data from 525 patients were evaluated, 189 underwent minithoracotomy and 336 underwent median sternotomy. The 30 day mortality was similar between the minithoracotomy and conventional surgery groups (1 and 3%, respectively; p = 0.25). No differences were seen in the incidence of stroke (p = 1.00), surgical site infections (p = 0.09), or myocardial infarction (p = 0.23), or in total hospital cost (p = 0.48). However, the minimally invasive approach was associated with fewer patients receiving transfusions (59% versus 76% in the conventional group; p = 0.001) or requiring reoperation for bleeding (3% versus 9%, respectively; p = 0.03). There were no significant differences in 5 year survival between the minithoracotomy and conventional surgery groups (93% versus 86%, respectively; p = 0.21) and freedom from mitral valve reoperation (95% versus 94%, respectively; p = 0.79). CONCLUSIONS: In patients undergoing mitral valve surgery, a minimally invasive approach is feasible, safe, and reproducible with excellent short-term outcomes; mid-term outcomes and efficacy were also seen to be comparable to conventional sternotomy.
- MeSH
- kardiochirurgické výkony * metody MeSH
- lidé středního věku MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony * metody MeSH
- mitrální chlopeň chirurgie MeSH
- nemoci srdečních chlopní chirurgie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- sternotomie * metody MeSH
- tendenční skóre MeSH
- torakotomie metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Background: Single-lung ventilation facilitates surgical exposure during minimally invasive cardiac surgery. However, a deeper knowledge of antibiotic distribution within a collapsed lung is necessary for effective antibiotic prophylaxis of pneumonia. Patients and Methods: The pharmacokinetics/pharmacodynamics (PK/PD) of cefuroxime were compared between the plasma and interstitial fluid (ISF) of collapsed and ventilated lungs in 10 anesthetized pigs, which were ventilated through a double-lumen endotracheal cannula. Cefuroxime (20 mg/kg) was administered in single 30-minute intravenous infusion. Samples of blood and lung microdialysate were collected until six hours post-dose. Ultrafiltration, in vivo retrodialysis, and high-performance liquid chromatography-tandem mass spectrometry were used to determine plasma and ISF concentrations of free drug. The concentrations were examined with non-compartmental analysis and compartmental modeling. Results: The concentration of free cefuroxime in ISF was lower in the non-ventilated lung than the ventilated one, evidenced by a lung penetration factor of 47% versus 63% (p < 0.05), the ratio between maximum concentrations (65%, p < 0.05), and the ratio between the areas under the concentration-time curve (78%, p = 0.12). The time needed to reach a minimum inhibitory concentration (MIC) was 30%-40% longer for a collapsed lung than for a ventilated one. In addition, a delay of 10-40 minutes was observed for lung ISF compared with plasma. The mean residence time values (ISF collapsed lung > ISF ventilated lung > plasma) could explain the absence of practically important differences in the time interval with the concentration of cefuroxime exceeding the MICs of sensitive strains (≤4 mg/L). Conclusion: The concentration of cefuroxime in the ISF of a collapsed porcine lung is lower than in a ventilated one; furthermore, its equilibration with plasma is delayed. Administration of the first cefuroxime dose earlier or at a higher rate may be warranted, as well as dose intensification of the perioperative prophylaxis of pneumonia caused by pathogens with higher MICs.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- atelektáza * farmakoterapie MeSH
- cefuroxim * MeSH
- mikrodialýza MeSH
- modely u zvířat MeSH
- prasata MeSH
- torakotomie MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
We present a very rare case of fatal complication during the cardiac surgery caused by unrecognized solitary metastasis of clear cell renal cell carcinoma in the sternum.
- Publikační typ
- kazuistiky MeSH
OBJECTIVES: Patients with a bicuspid aortic valve (BAV) often present with a dilated ascending aorta. However, the underlying pathogenesis for the observed changes in the aortic wall and the resulting aneurysmal dilation remains a subject of debate. This study aims to compare the histological abnormalities of the ascending aorta in BAV and tricuspid aortic valve (TAV) patients and their correlation with aortic diameter and patient age. METHODS: A total of 376 patients from our institution's clinical database were included in the retrospective analysis. These patients underwent either elective surgery for ascending aorta dilation or emergency surgery for aortic dissection, either isolated or with a structurally diseased aortic valve. After excision, the ascending aorta samples were analysed by a pathologist. RESULTS: On histological examination, a higher degree of elastic fibre fragmentation and loss and mucoid extracellular matrix accumulation was present in the samples from TAV patients when compared with that from BAV patients (P < 0.001). However, correlation was poor for all variables when considering aortic diameter and histological abnormalities or age and histological abnormalities in both BAV and TAV patients. CONCLUSIONS: Our study demonstrates a greater incidence of severe histological abnormalities in TAV patients when compared with BAV patients.
- MeSH
- aorta MeSH
- aortální chlopeň * MeSH
- dilatace patologická MeSH
- lidé MeSH
- nemoci srdečních chlopní * MeSH
- retrospektivní studie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Objectives. Female sex has been generally accepted as a risk factor for short-term mortality and adverse events in surgical myocardial revascularization. However, there have been no data published yet about sex differences in minimally invasive settings. The aim of our study was to analyse short- and long- term outcomes of minimally invasive direct coronary artery bypass grafting (MIDCAB) in terms of sex comparison. Design. We retrospectively analysed the in-hospital data of all patients (n = 384) undergoing MIDCAB at our department in years 2006-2016. Subsequently, the data were enriched by long-term outcomes from national registries. Results. There were 96 women in our group (25%). Females were significantly older (67.1 vs 63.8 years; p < .01) and were more often diabetic (43.8% vs. 31.8%; p < .01). Surgery time was longer in females (160 vs 155 min; p = .02), and also the need for blood transfusion (19.8% vs 10.4%; p = .02) and wound complications (15.6% vs 2.4%; p < .001) were more frequent in women. After multivariate analysis, the wound complications risk (p < .001) and longer surgery times (p < .01) remained associated with sex. All-cause in-hospital mortality (2.1% vs 0.7%; p = .26), long-term mortality (p = .73), and the risk of coronary intervention post-operatively (p = .16) were the same in both sexes. Higher incidence of cardiac cause of death in women was observed from long-term aspect (69.6% vs 38.7%; p = .01). However, after adjustment it lost its significance. Conclusions. Female sex is not connected with higher risk of mortality or other major events in MIDCAB. Wound healing complications remain the leading attribute associated with female sex.
- MeSH
- časové faktory MeSH
- hodnocení rizik MeSH
- hojení ran MeSH
- koronární bypass škodlivé účinky mortalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- mortalita v nemocnicích MeSH
- nemoci koronárních tepen mortalita chirurgie MeSH
- pooperační komplikace etiologie mortalita terapie MeSH
- retrospektivní studie MeSH
- rizikové faktory MeSH
- senioři MeSH
- sexuální faktory MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- srovnávací studie MeSH
Perikardiální cysty jsou vzácné mediastinální útvary s incidencí 1:100 000. Obvykle jsou asymptomatické, náhodně zachycené zobrazovacím vyšetřením. Asymptomatické perikardiální cysty řešíme obvykle konzervativně, v případě symptomatických je indikována chirurgická léčba či perkutánní aspirace. Prezentujeme případ pacienta s objemnou perikardiální cystou, jež se manifestovala bolestí na hrudi a prekolapsem, úspěšně extirpovanou s pomocí videoasistované thorakotomie.
Pericardial cysts are rare mediastinal abnormalities with an incidence rate of 1 per 100,000. They are mostly asymptomatic, discovered incidentally during routine imaging examination. The management of pericardial cysts depends on their size and symptoms, where asymptomatic ones are usually observed, while symptomatic ones are indicated for a surgical resection or percutaneous aspiration. We report the case of patient with giant pericardial cyst presenting with chest pain and precollapse, successfully extirpated using video- assisted thoracoscopic surgery
- MeSH
- bolesti na hrudi etiologie chirurgie komplikace terapie MeSH
- cysty mediastina * diagnóza klasifikace terapie MeSH
- diagnostické zobrazování metody využití MeSH
- dospělí MeSH
- hrudní chirurgické výkony metody využití MeSH
- lidé MeSH
- perikard * anatomie a histologie patofyziologie patologie MeSH
- statistika jako téma MeSH
- thorakocentéza metody využití MeSH
- torakotomie metody využití MeSH
- video-asistovaná chirurgie metody využití MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH