Telematics in medicine: a network infrastructure to optimize processes in cardiology and heart surgery.

OBJECTIVES: During the past 2 decades, cardiac surgery has developed into a high-tech field. Increasing numbers of urgent surgical procedures mean that the time interval from diagnosis to surgical treatment must become ever shorter. Optimizing inconvenient and slow processes such as postal correspondence by using internet services is therefore mandatory in current cardiosurgical practice, and this includes the electronic transfer of patient data and diagnostic imaging material [12]. This study focuses on the internet connection of several cardiac referral centers to a cardiosurgical institution. METHODS: Eleven cath lab centers were connected to a cardiosurgical center by internet. Auser program was especially developed to optimize connecting processes with the department. Data conversion was based on HL7 codes and angiograms were based on CD-ROM mediums and the DICOM standard. An online registration based on the HL7 communications standard was provided. RESULTS: All cath lab centers were successfully connected to the cardiosurgical institution. Angiography data were transmitted within 30 +/- 15minutes. The time interval from diagnosis to decision for surgery decreased from 36 +/- 13 hours to 1 +/- 0.5 hours (p = 0.01). Urgent or emergent surgery could be provided after 18 +/- 19 hours, compared to 56 +/- 35 hours before (p = 0.02). CONCLUSION: Special programs transmitting data via the internet significantly reduces the time interval from diagnosis to surgical treatment. Standardizing data transmitting processes from referral centers markedly optimizes cardiological and cardiosurgical treatments and could thereby improve survival rates and reduce costs.

Cardiothoracic surgery after heart and heart-lung transplantation.

OBJECTIVE: We sought to examine our management and the outcomes of cardiothoracic procedures after heart and heart lung transplantation. METHODS: We performed a retrospective review of cardiothoracic surgical procedures carried out between 1990 and 2004 in patients who had previously undergone heart or heart-lung transplantation at our institution. RESULTS: Twenty-one out of 340 patients (6.2 %) were identified. Cardiothoracic surgery was performed 44.4 +/- 33 months (range 1 - 115 months) after transplantation. Predominant types of surgery were coronary artery bypass grafting due to allograft vasculopathy (n = 5), aortic surgery due to acute dissection (n = 3), biventricular assist device implantation due to acute rejection (n = 1), tricuspid valve repair (n = 1), multiple cardiac surgical procedures including coronary artery bypass grafting, retransplantation, and tricuspid valve replacement (n = 2), explantation of a functionless heterotopic transplanted heart (n = 1). Lung surgery was performed in six patients due to pneumonia (n = 2), primary lung carcinoma (n = 3), lung torsion following heart-lung transplantation (n = 1). All patients underwent either lobectomy or segmental lung resection. Single lung retransplantation (n = 2) after prior heart-lung transplantation due to bronchiolitis obliterans was performed. In one patient a pneumonectomy (n = 1) due to severe chronic rejection of the contralateral lung was performed. Six subsequent deaths after cardiothoracic procedures were recorded after 1, 4, 78, 163, 205, and 730 days, respectively. Causes of death were advanced carcinoma (n = 1), multi-organ failure due to sepsis (n = 2), sudden heart death (n = 2), and advanced heart failure (n = 1). Fifteen out of 21 patients having undergone cardiothoracic procedures (71.4 %) survived the observation period of 56.6 +/- 34 months (range 1 - 114). CONCLUSIONS: Reasons for cardiothoracic procedures after prior heart or heart-lung transplantation were allograft vasculopathy, aortic dissections years after transplantation, chronic rejection, and either lung infections or malignancies. Surgical repair can be performed with an acceptable operative risk and good long-term survival rates.