The Journal of cardiovascular nursing
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Mitral valve repair is the standard therapy for patients with severe mitral regurgitation. Currently, robotic mitral valve repair is the least invasive surgical approach and an alternative to the traditional sternotomy. Recent studies and newer guidelines on mitral valve repair advocate for earlier referral to surgery, resulting in better long-term outcomes of valve function and decreased left ventricular remodeling. ⋯ Patients should be given the option for minimally invasive robotic mitral valve repair if they have no other risk factors such as peripheral vascular disease that prevent femoral cannulation for cardiopulmonary bypass or the need for concomitant cardiac surgery such as coronary artery bypass. With the equality of robotic outcomes compared with full sternotomy valve surgery comes the need for more research into what kind of complex valve repairs can be done, which methods of repair work best with robotic techniques, whether the learning curve for robotic surgery can be shortened with more widespread use, and what outcomes can be improved upon from this standpoint. Healthcare professionals need to be aware of all choices for patients who need surgical intervention for their mitral regurgitation.
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The course of incident delirium and subsyndromal delirium (SSD) after cardiac surgery is not well studied. ⋯ Delirium and SSD after CABG are common. Greater number and severity of risk factors for delirium may predict increasingly poor outcomes, with the dose-response relationship between risk factors and outcomes for SSD intermediate between that for no symptoms and full delirium. Intervention trials are indicated, particularly for patients with a greater number and severity of predisposing and precipitating risk factors.