ABSTRACT
Despite a strong national commitment to excellence in healthcare, the available resources are limited. Cardiac surgery consumes more healthcare resources than any other single treatment. It is imperative that healthcare professionals evaluate the traditional methods used to deliver quality care. Rapid recovery programs have been implemented in response to this challenge. The purpose of this article is to discuss development, implementation, and outcome evaluation of a rapid recovery program for cardiac surgery patients in a single health center. A multidisciplinary team examined care before, during, and after surgery, as well as after discharge. The team also evaluated standards of care and CARE Pathways. Changes in protocols were made to prevent the predictable complications of cardiac surgery. A decrease in intubation time, respiratory infections, wound infections, laboratory procedures, length of stay, and costs has been demonstrated. In a follow-up patient and family survey, high satisfaction with nursing care, patient and family education, and length of hospitalization has been voiced. Anticipated goals have been exceeded and improvements in standards continue to be made.
Subject(s)
Cardiac Surgical Procedures/rehabilitation , Critical Pathways , Postoperative Care/methods , Adult , Aftercare , Aged , Aged, 80 and over , Cardiac Surgical Procedures/nursing , Critical Care , Exercise , Female , Humans , Length of Stay , Male , Middle Aged , Missouri , Patient Care Team , Patient Education as Topic , Patient Satisfaction , Postoperative Care/economics , Postoperative Complications , Respiration, Artificial , Time FactorsABSTRACT
The role of retrograde coronary sinus cardioplegia in patients undergoing aortic valve replacement for aortic stenosis alone or in combination with myocardial revascularization has not been fully defined. Sixty-three patients undergoing elective aortic valve replacement received cold potassium blood cardioplegic solution via either the aortic root (36 patients) or the coronary sinus (27 patients). The patients were similar with respect to age, degree of aortic stenosis, ventricular function, severity of coronary artery disease, crossclamp time, completeness of revascularization, and mean volume and temperature of the infusion solution. The mean septal temperature and the release of myocardium-specific isoenzyme in the first 2 hours after crossclamp removal was higher in the retrograde group (p less than 0.008). Right and left ventricular function was preserved equally in the two groups, and volume-loading studies suggested improved diastolic performance in patients having retrograde cardioplegia. There were no differences between the two groups with respect to clinical outcome. We conclude that coronary sinus cardioplegia is as safe as aortic root perfusion for myocardial preservation in patients undergoing elective aortic valve replacement.
