Vasudev Baburaya Pai

Effect of Preoperative Education on Postoperative Outcomes Among Patients Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Purpose: The objective of this review was to assess the effect of preoperative education on postoperative outcomes among patients undergoing cardiac surgery. Design: Systematic review and meta‐analysis. Methods: A comprehensive literature search was made on PubMed, CINAHL, Ovid, ProQuest, ScienceDirect, Scopus, Web of Science, and the Cochrane database between 1995 and 2015. Fourteen randomized controlled trials were included. Data analysis was performed with RevMan software and created the Supplementary Appendix using the GRADE approach. Findings: Meta‐analysis showed that preoperative education reduced anxiety scores (standardized mean difference = −0.96, 95% confidence interval: −1.37, −0.54; P < .0001). However, there was no significant effect of preoperative education on pain, depression, and length of hospital stay. There is low‐quality evidence, and reasons for downgrading are due to study design limitations, inconsistency, and imprecision of effect estimates. Conclusions: The results show that preoperative education can effectively decrease anxiety in patients undergoing cardiac surgery.

A giant ‘sausage’ thrombus in the left ventricle in a patient with preserved ventricular function

A 49-year-old man had presented to us 2 years ago with a history of recent anterior wall myocardial infarction which was treated at another hospital. An echocardiogram was performed which revealed mild regional wall motion abnormality involving the apical segments with good overall left ventricular (LV) function and normal ejection fraction. There was a small mass, measuring 1.1×0.8 cm, at the apex which was diagnosed to be an organised thrombus (figure 1 and video 1). He was started on anticoagulation and discharged. He was subsequently lost to follow-up. He presented almost 18 months …

Effect of Complementary Therapies in Patients Following Cardiac Surgery: A Narrative Review

Cardiovascular diseases are increasing rapidly and have become a major health problem worldwide. The incidence and prevalence of cardiovascular disease are increasing rapidly, predominantly in the developing countries. Patients with cardiovascular disease who do not respond to routine medical treatment will have to follow cardiac surgical procedures. The objective of this study was to apprise the evidence of the effect of various complementary therapies on postoperative outcomes among patients undergoing cardiac surgery. A comprehensive literature search was made on PubMed-Medline, CINAHL, Science Direct, Scopus, Web of Science, and the Cochrane Library databases for original research studies published between 2000 and 2015. Original articles that reported the effect of complementary therapies in patients undergoing cardiac surgery were included. Twenty-eight studies were analyzed, and they have produced conflicting results. Most of the studies (n = 25) have documented the effects of complementary therapies on improving postoperative outcomes of patients, whereas other studies (n = 3) found no evidence of improvement. Although methods varied considerably, most of the studies included in this review reported positive results. Therefore, there is some evidence that complementary therapies can lead to positive postoperative outcomes. Evidence of the efficacy of complementary therapies in cardiac surgical patients remains inconclusive. Additional research is needed to provide a strong evidence base for the use of complementary therapies to improve postoperative outcomes and recovery in patients undergoing cardiac surgery.

Delayed repair for aortic root abscess - is it justified?

Results A 55 yr old gentleman presented with high grade fever since 2mths and dyspnoea on exertion since 1mth. Echocardiography revealed severe AR with vegetations and a diagnosis of infective endocarditis was made after blood cultures grew coagulase negative staphylococcus. He was in pulmonary oedema on presentation with renal failure needing non-invasive ventilator support and low dose inotropes. He responded to appropriate intravenous antibiotics. He was investigated for malaena and CT scan showed splenomegaly with cirrhosis suggestive of portal hypertension and there was suspicion of an aortic root abscess. Upper GI scopy showed oesophageal varices. He was referred for aortic valve replacement. Repeat transoesophageal echocardiograms did not show the root abscess and his renal dysfunction contraindicated repeat CT scans. He was taken up for banding for varices and surgery was delayed for a month. The inflammatory markers returned to normal; renal function recovered to normal and heart failure resolved as well. Appropriate antibiotic cover was continued for the 4 weeks after banding. An elective aortic valve replacement was planned with a tissue valve considering the varices. At surgery a cavity of 0.5 cm × 0.5 cm × 1 cm was found between the LCCRCC junction medial to the pulmonary artery. The annulus was reconstructed with obliteration of the cavity. He made a good recovery thereafter.

Tuberculosis can cause anything in the world except pregnancy

Results A 37 year old male patient presented with class III dyspnoea on exertion. He was hypertensive with dialysis dependent end stage renal disease and dialysed using an AV Fistula on the left upper limb. Echocardiography showed severe AR and LV dysfunction. CT Coronary angiography showed aortic root to be 5 cm and saccular aneurysms in the circumflex and the right coronary artery with complete occlusion of RCA. A Bentall procedure was planned. Intraoperatively, there was a mass arising from anterior chest wall measuring 6 cm × 5 cm attached to the Left Internal Mammary artery with multiple enlarged paratracheal and mediastinal lymph nodes. Frozen section from the mass and lymph nodes did not reveal any malignancy. The oncosurgeon felt that the mass was malignant looking at its extent and CT characteristics. Pragmatically a mechanical aortic valve replacement and saphenous vein grafts to the OM and PDA were performed after a discussion between the clinicians instead of a root replacement. The final histopathology showed tuberculosis of the lymph nodes with no malignancy in the mass. The patient underwent dialysis postoperatively and needed inotropes till day 4. He was started on anti-tuberculosis medications and was discharged on postoperative day 10. In retrospect the coronary aneurysms and the root dilatation with aortic regurgitation could have been caused by tuberculosis.

When images lie: a variant of suprascapular artery found incidentally

Left internal thoracic artery (LITA) injection during coronary angiography of a 57-year-old man taken for coronary artery bypass graft showed a large branch arising very high from the LITA, about 1 cm past its origin. Even after harvesting the LITA to a very high extent to get this branch, it could not be found (figure 1). Hence, it was decided to dissect up to the origin of the LITA. The internal mammary vein accompanying the LITA was divided between ligaclips. This allowed clear visibility of the subclavian vein, which was then traced to its drainage into the internal jugular vein. The subclavian vein was obscuring vision of the left …

Left maxillary artery pseudoaneurysm: a rare and late postoperative complication after head and neck cancer treatment

We report a case of a 50-year-old man presented with pulsatile swelling in the left side of the face since 2 months and a continuous sinus discharge since 3 days. Three years earlier, he was operated for squamous cell carcinoma (SCC) of the left lower alveolus and underwent surgical excision with myocutaneous flap reconstruction, followed by chemoradiotherapy. CT angiogram of the expansile swelling revealed pseudoaneurysm of third part of the left maxillary artery and treated by surgical intervention.