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Outcomes of continuous flow ventricular assist devices

World Journal of Surgical Procedures 2014年第1期4卷 1-8页

作者： shelly bansal Chittoor B Sai-Sudhakar Bryan A Whitson Division of Thoracic Transplantation Department of Cardiothoracic Surgery University of Pittsburgh Pittsburgh PA 15260 United States Division of Cardiac Surgery Department of Surgery The Ohio State University Columbus OH 43210 United States Division of Cardiac Surgery The Collaboration for Organ Perfusion Protection Engineering and Regeneration (COPPER) Laboratory The Ohio State University Wexner Medical Center Columbus OH 43210 United States

Heart transplantation is commonplace, the supply is limited. Many exciting changes in the field of mechanical circulatory support have occurred in the past few years, including the axial flow pump. Left ventricular assist device(LVAD) therapy is ever evolving. As the use of LVAD therapy increases it is important to understand the indications, surgical considerations and outcomes.

关键词： Left ventricular assist device Axial flow Mechanical circulatory support Heart failure Continuous flow

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Fast Track Extubation Post Coronary Artery Bypass Graft: A Retrospective Review of Predictors of Clinical Outcomes

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World Journal of Cardiovascular Surgery 2013年第2期3卷 81-86页

作者： shelly bansal H. M. Thai C. H. Hsu C. B. Sai-Sudhakar S. Goldman B. E. Rhenman Cardiology Section (1-111C) Southern Arizona VA Health Care System Tucson USA Department of Cardiac Surgery The Ohio State University Columbus USA Department of Cardiothoracic Surgery University of Arizona Health Sciences Center Tucson USA Department of Surgery University of Arizona Tucson USA Division of Epidemiology and Biostatistics Mel & Enid Zuckerman College of Public Health University of Arizona Tucson USA

Introduction: Fast track (FT) cardiac surgery and early extubation (EE) are aimed at safe and effective rapid post-operative progression to discharge, and have been practiced for more than two decades. Their goal is to optimize patient care perioperatively in order to decrease costs without negatively affecting morbidity and mortality. However, the factors that predict successful EE are poorly understood, and patients with significant co-morbidities are frequently excluded from protocols. We hypothesize that independent of disease severity, early extubation leads to shorter hospital stays and can be performed safely without negatively affecting outcomes. Materials and Methods: We performed a retrospective review of 919 patients who underwent coronary artery bypass grafting (CABG) at the Southern Arizona Veteran’s Affairs Health Care System medical center over 7 years. We collected pre-operative data regarding patients’ NYHA classification, presence and severity of cerebral vascular disease, peripheral vascular disease, pulmonary disease, diabetes and hypertension. Intra-operative variables were also recorded including ASA scores, ischemic times, and time to extubation. Finally, post-operative variables such as rates of reintubation and tracheotomy, and both length of ICU and total hospital stay were also compared. Results: Prolonged periods of ischemia were found to predict a delayed extubation (HR = 0.992;CI = 0.988 - 0.997, p = 0.0015) while small body surface area (HR = 1.57;CI = 1.13, 2.17, p = 0.007) and higher pre-operative functional status of the patient, such as independent versus dependent status (HR =1.68;CI = 1.30 - 2.16, p = 1.33;CI = 1.03 - 1.70, p = 0.03) were found to be associated with earlier extubation. The early extubation (EE) group (those extubated in less than the median 7.3 hours) had an average hospital stay of 5.1 ± 4.0 days, versus 7.8 ± 8.1 days in the delayed group (>4 hours), p Conclusions: In our study population, pre-operative functio

关键词： Coronary Artery Bypass Fast Track Early Extubation Postoperative Period Intensive Care Intubation Treatment Outcome Airway Extubation

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