RESUMEN
The temporary pacing is provided as a key principle of maintenance and correction of hemodynamics after weaning the patient from cardiopulmonary bypass. There are conventional algorithms of temporary pacing, but the substantiation of electrode fixation areas is variable. The authors experimentally investigated the efficacy of temporary epicardial pacing in DDD and DDDBV using 18 laboratory animals after cardiac surgery with application of cardiopulmonary bypass. The hemodynamic parameters were compared in given groups. It was noted that in case of temporary epicardial pacing in DDDBV conditions was the best hemodynamic effect. The authors recommended more optimal areas for electrode fixation in temporary pacing: bachmans bunble (closest to the artrial septum), proximal part of the crista terminalis for the right atrium electrodes; the front-side free wall of the right ventricle at the distance of 3-4 cm from the apex of the heart, diaphragmatic surface of the right ventricle proximal to artioventricular groove for the right ventricle electrodes; obtuse margin (side wall of the left ventricle), diaphragmatic surface of the left ventricle proximal to artioventricular groove for the left ventricle electrodes.
Asunto(s)
Dispositivos de Terapia de Resincronización Cardíaca , Terapia de Resincronización Cardíaca/métodos , Procedimientos Quirúrgicos Cardíacos , Puente Cardiopulmonar , Complicaciones Posoperatorias/prevención & control , Retención de la Prótesis/métodos , Animales , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Puente Cardiopulmonar/efectos adversos , Puente Cardiopulmonar/métodos , Hemodinámica , Modelos Anatómicos , Modelos Animales , Periodo Posoperatorio , Porcinos , Resultado del TratamientoRESUMEN
A retrospective analysis of cases of sternal infection development was made in 388 cardiovascular patients from 2006 to 2012. The standard preventive measures of wound infection development were applied in the first period from 2006 to 2009. The method of "elimination of sternal infection" was used in the second period from 2009 to 2012. The application of the method of "elimination of sternal infection" allowed reducing the rate of sternal infection from 7.7 to 0.5% (odds ratio 0.099, 95% CI: 0.013-0.747; p = 0.025). According to results of statistical analysis the most significant factors were: body mass index (p = 0.002), resternotomy in early postoperative period (p < 0.001), risk according EuroSCORE Logistics (p < 0.001) and usage of the method of "elimination of sternal infection" (p = 0.006). The prevention of postoperative infectious complications shorthens the terms of hospital stay no less than 3 weeks, improves the quality of life for the patients and decreases treatment costs on 2.5 times.
Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Calidad de Vida , Esternotomía , Esternón , Infección de la Herida Quirúrgica , Adulto , Índice de Masa Corporal , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Enfermedades Cardiovasculares/cirugía , Femenino , Humanos , Tiempo de Internación , Masculino , Estudios Retrospectivos , Factores de Riesgo , Prevención Secundaria/métodos , Esternotomía/efectos adversos , Esternotomía/métodos , Esternón/patología , Esternón/cirugía , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Infección de la Herida Quirúrgica/psicología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Materiales Biocompatibles , Enfermedades Cardiovasculares/cirugía , Procedimientos Quirúrgicos Cardiovasculares , Prótesis e Implantes , Materiales Biocompatibles/clasificación , Materiales Biocompatibles/historia , Procedimientos Quirúrgicos Cardiovasculares/historia , Procedimientos Quirúrgicos Cardiovasculares/instrumentación , Procedimientos Quirúrgicos Cardiovasculares/métodos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Evaluación de Necesidades , Evaluación de Procesos y Resultados en Atención de Salud , Prótesis e Implantes/clasificación , Prótesis e Implantes/historiaRESUMEN
The estimation of frequency of occurence of atrial fibrillation in patients with mitral valvular diseases was made before operation and at the early postoperative period. A logistic regressive analysis has shown that the appearance of atrial fibrillation in long-term periods is influenced by 4 independent preoperative factors: preoperative atrial fibrillation, age, anterior-posterior size of the left atrium, diagnosis of rheumatism. The dependence of the appearance of atrial fibrillation on the preoperative status of the patient was detected. A statistical model having the prognostic value 89.6% has been constructed. The model is good in use, reliable and can be effectively used in everyday clinical practice in order to determine the probability of the appearance of atrial fibrillation at the postoperative period of the concrete patient and decision on necessity of surgical ablation.
