The Annals of thoracic surgery
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We describe a case of hypotension on cardiopulmonary bypass for coronary artery bypass grafting, double valve repairs, and patent foramen ovale closure. The patient experienced vasoplegic syndrome while on cardiopulmonary bypass. He was treated with high-dose hydroxocobalamin (vitamin B12). His blood pressure responded rapidly, obviating any further vasopressor requirements.
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We report a new technique of establishing a direct coronary transfer for anomalous left coronary artery arising from the nonfacing sinus of the pulmonary artery. This easily reproducible technique was successfully used in 2 patients. It achieves a dual coronary repair without the use of complex aortic or pulmonary arterial flaps and without causing any distortion to the great vessels.
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Randomized Controlled Trial Multicenter Study Comparative Study
Safe application of a restrictive transfusion protocol in moderate-risk patients undergoing cardiac operations.
Perioperative red blood cell transfusion is associated with adverse outcomes after cardiac operations. Although restrictive transfusion protocols have been developed, their safety and efficacy are not well demonstrated, and considerable variation in transfusion practice persists. We report our experience with a restrictive transfusion protocol. ⋯ A restrictive transfusion protocol can be safely applied in the care of moderate-risk patients undergoing cardiac operations. This strategy has significant potential to reduce transfusion and resource utilization in these patients, standardize transfusion practices across institutions, and increase the safety of cardiac operations.
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Randomized Controlled Trial Comparative Study
Informed consent for cardiac procedures: deficiencies in patient comprehension with current methods.
Patients who undergo cardiac catheterization or percutaneous coronary intervention (PCI) often have a poor understanding of their disease and of related therapeutic risks, benefits, and alternatives. This pilot study was undertaken to compare the effectiveness of 2 preprocedural educational approaches to enhance patients' knowledge of standard consent elements. ⋯ Although both scripted verbal and audiovisual informed consent improved patient comprehension, important patient misperceptions regarding PCI-related outcomes and alternatives persist, independent of informed consent approach, and considerable challenges still exist in educating patients about contemplated medical procedures. Future research appears warranted to improve patient comprehension.
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Comparative Study Observational Study
Cardiac surgery nurse practitioner home visits prevent coronary artery bypass graft readmissions.
We designed and tested an innovative transitional care program, involving cardiac surgery nurse practitioners, to improve care continuity after patient discharge home from coronary artery bypass graft (CABG) operations and decrease the composite end point of 30-day readmission and death. ⋯ A home transition program providing continuity of care, communication hub, and medication management by treating hospital nurse practitioners significantly reduced the 30-day composite end point of readmission/death after CABG. More targeted resource allocation based on odds ratios of readmission may further improve results and be applicable to other patient groups.