Tag Archives: cardiac surgery

Introduction In the UK, over 35,000 cardiac operations are performed annually.1 Traditionally, patients who have undergone cardiac surgery return to the outpatient clinic for their first postoperative review by the specialist team six weeks after hospital discharge. There is no evidence to show that six weeks is the optimal interval before these patients, with ongoing risks of postoperative complications, are reviewed. Not infrequently, after hospital discharge, cardiac surgery patients make unplanned hospital visits and/or require readmission during the six-week wait for outpatient review, due to surgery-related complications.2-4 While readm

Introduction Figure 1. Diagnostic coronary angiogram via right femoral artery illustrating the presence of a large tortuous right coronary artery (RCA) with collaterals filling the left coronary arterial system (LCA) and retrograde flow of contrast within the main pulmonary artery (PA) Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital condition that often proves fatal in infants. However, we present a case of a young patient presenting with angina-like chest pains since childhood, who subsequently underwent successful surgical correction resulting in alleviation of symptoms. Case report A 25-year-old

Introduction Warfarin is an anticoagulant commonly used in atrial fibrillation, venous thromboembolism, prosthetic cardiac valve replacement and postoperative atrial fibrillation.1 Warfarin is usually discontinued prior to cardiac surgery and subsequently re-initiated postoperatively to achieve the target therapeutic international normalised ratio (INR).2 At the cardiac surgery unit of St. Paul’s Hospital, it has been observed that the warfarin dosage needed to achieve therapeutic anticoagulation is often lower post-cardiac surgery, compared with the patient’s warfarin dose prior to cardiac surgery. Serious complications, such as postoper

Dr Ravi De Silva (Papworth Hospital NHS Foundation Trust) Many factors influence patient outcomes after surgery.1,2 Broadly speaking these may be categorised into factors present prior to hospital admission (e.g. comorbidities), factors occurring during the operation (e.g. technical error, unexpected operative findings), and factors occurring post-operatively (e.g. infections, medication error). A single individual is not able to control all of these variables, so patient deaths should not be attributed to an individual. The public may also be unaware that there exists great variation in the quantity and quality of staffing, expertise and equ

Chronic pain after cardiac surgery: prevalence and impact With the growing burden of cardiovascular disease, the number of people undergoing cardiac surgery, globally, is expected to continue to rise.1 In 2010, 31,613 cardiac surgeries were performed in England and Wales,2 and prevalence data are similar in other Commonwealth countries, including Canada.2,3 While the primary aims of cardiac surgical procedures (including coronary artery bypass grafting [CABG] and valve replacement) are to improve survival, ameliorate symptoms (such as angina) and improve health-related quality of life (HRQL), mounting evidence suggests that the development of

Introduction It is accepted that coronary revascularisation with coronary artery bypass graft surgery (CABG) provides both symptomatic and prognostic benefit in patients with multi-vessel coronary artery disease (mvCAD).1,2 Both percutaneous coronary intervention (PCI) and CABG provide better relief of angina symptoms than medical therapy alone.1,3 Large, randomised-controlled trials (RCTs), in recent years, have demonstrated that CABG offers an improved outcome in patients with complex three-vessel coronary artery disease (CAD), especially in those with co-existing diabetes mellitus.4,5 However, in patients with one- or two-vessel CAD, PCI o

Choice of surgery The mainstay of cardiac surgery is CABG, which is performed for both symptomatic and prognostic reasons. In elderly asymptomatic patients, the prognostic value of the operation has to be thought through carefully and in the context of the patient’s general health and lifestyle. The overall risk following CABG in patients older than 80 years is approximately 8%.2 Recently, there has been an increase in the number of elderly patients referred for cardiac surgery. One of the reasons is the emergence of minimally invasive techniques like transcatheter aortic valve implantation (TAVI) and off-pump CABG (beating heart). It was

Introduction The average age and risk profile of patients undergoing cardiac surgery are steadily increasing and present new sets of challenges to surgical care. Whereas the clinical implications of this demographic change continue to be the focus of ongoing investigation,1,2 the impact on care and clinical resource utilisation has not been clearly defined, even though studies have shown higher costs for octogenarians.3,4 Cost of care is a major issue in healthcare delivery, and cost-effectiveness in universal healthcare schemes like the National Health Service (NHS) is critical to sustainability.5,6 The core founding principles of the NHS �

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