Heart, lung & circulation
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Heart, lung & circulation · Dec 2019
Long-Term Results Following Repair for Degenerative Mitral Regurgitation - Analysis of Factors Influencing Durability.
The majority of patients with degenerative mitral regurgitation (DMR) are amenable to reconstructive procedures. There is debate regarding factors that influence long-term durability with respect to repair technique, valve remodelling and progressive myxomatous change. ⋯ The great majority of degenerative mitral valves are repairable regardless of age with excellent long-term results achievable following surgery. Survival is reduced by significant symptoms, LV dysfunction and preoperative PAF. Repair is best performed before these features develop. Durability is largely dependent on the technical performance of the repair and degree of residual MR on the post-pump transoesophageal echocardiogram. We recommend surgery should be performed by surgeons specialising and skilled in mitral valve repair.
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Heart, lung & circulation · Dec 2019
Early Discharge From Intensive Care After Cardiac Surgery is Feasible With an Adequate Fast Track, Stepdown Unit: Waikato Experience.
Enhanced recovery programs within cardiothoracic surgery are a well described benefit to patient postoperative outcomes. We describe our Australasian unit's experience of a day zero discharge enhanced recovery unit from the intensive care department. ⋯ A fast track unit increases the efficiency of an ICU and cardiac surgical department. With the advancements of cardiac surgery a higher number of patients will be suitable for a fast track method. Our unit has demonstrated that a day zero fast track unit in New Zealand can perform with adequate patient safety with no increased risk of mortality and with low rates of failure of the day zero discharge fast track therapy.
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Heart, lung & circulation · Nov 2019
Assessment of the EuroSCORE II in a New Zealand Tertiary Centre.
The updated European System for Cardiac Operative Risk Evaluation (EuroSCORE II) is a well-established cardiac surgery risk scoring tool for estimating operative mortality. This risk stratification system was derived from a predominantly European patient cohort. No validation analysis of this risk model has been undertaken for the New Zealand population across all major cardiac surgery procedures. We aim to assess the efficacy (discrimination and calibration) of the EuroSCORE II for predicting mortality in cardiac surgical patients at a large New Zealand tertiary centre. ⋯ EuroSCORE II showed a strong discriminative ability for isolated CABG 30-day mortality in a New Zealand patient cohort. However, the scoring system discriminated poorly across valvular, thoracic aortic or complex combination cardiac surgical procedures. Good calibration of the EuroSCORE II was achieved across both the total cohort and subgroups. It is important to consider the performance of other cardiac surgery risk stratification models for the New Zealand population.
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Heart, lung & circulation · Oct 2019
ReviewThe Prophylactic Chimney Snorkel Technique for the Prevention of Acute Coronary Occlusion in High Risk for Coronary Obstruction Transcatheter Aortic Valve Replacement/Implantation Cases.
Coronary occlusion (immediate or delayed) is an uncommon but potentially devastating complication of transcatheter aortic valve replacement/implantation (TAVR/TAVI). Several patient-related, anatomical, device and procedural risk factors can be assessed to risk-stratify patients and assist in procedural planning. ⋯ In the highest risk patients, consideration should be given to prophylactic techniques to prevent coronary occlusion. This how-to-do-it report provides a framework for risk assessment for coronary occlusion followed by a step-wise description of the emerging chimney snorkel coronary stenting technique as a predictable procedural approach for the management of this potentially challenging clinical scenario.
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Heart, lung & circulation · Aug 2019
Randomized Controlled TrialThe Effects of Tai Chi on Lung Function, Exercise Capacity and Health Related Quality of Life for Patients With Chronic Obstructive Pulmonary Disease: A Pilot Study.
Although several studies have assessed the effect of Tai Chi in management of chronic obstructive pulmonary disease (COPD), these studies have a wide sample variation and convey inconclusive results. This study aims to determine if a 3-month Tai Chi program improves lung function, exercise capacity, and health related quality of life (HRQoL) in people with COPD. ⋯ The Tai Chi program is a safe, effective and feasible method to improve exercise capacity and health-related quality of life in people with COPD.