Additionally, Jamieson et al highlighted several predictive factors such as age, concomitant coronary artery bypass graft, urgency status, NYHA class, and reoperation time. The overall mortality, as well as mortality for elective status and urgency/emergent status was 11.9%, 6%, and 17.8%, respectively. In general, redo MVR mortality rate may be low in elective status with low to medium NYHA function class. The routine evaluation of patients can lead to a lower risk of redosurgery as well (5). In a study by Jones et al (12) on 671 patients, primary redo-surgery mortality, the mortality of redo-surgery due to unsuccessful repair, in redo-surgery for prosthetic valve dysfunction or periprosthetic leakage, and in redo-surgery for endocarditis or valve thrombosis were 8.6%, 3%, 10.6%, and 29.4%, respectively. Concomitant coronary artery bypass graft was related to a mortality of 15.4% compared to when it was unnecessary (8.2%). Similarly, the mortality was 6.4%, 7.4%, 2.2%, 25.6%, and 9.1% for AVR, mitral valve, isolated valve repair, tricuspid valve replacement, and periprosthetic leakage repair, respectively. Among the 336 patients who required the replacement of the prosthetic valve, the mortality for redo-surgery in the prosthetic valve was 26% compared to 8.6% for tissue valve replacement (P < 0005). In addition, the mortality was higher for redo heart valve surgery when compared to primary valve surgery. The causes of mortality included heart failure (51.7%), hemorrhage (15.5%), endocarditis (10.3%), bronchopneumonia (6.9%), myocardial infarction (5.2%), multi-organ failure (3.5%), renal failure (3.5%), CVA (1.7%), and acute abdomen (7%).
reduces the chances of multi organ failure by upto 60% and has an impact on mortality (Hutchins RR, Gunning MP, Lucas DN, et al., 2004). In their study, mean time interval between index and redosurgery was 5 days. In the study by Koirala R, Shakya VC, Khania S, et al. (2012) the mean time. In this study the most common complication following redosurgery was Septicemia 40%(n=10) patients, closely followed by complications of respiratory origin 36%(n=9) and wound infection 24%(n=9). 4 patients had all the above mentioned complications, 3 patients had pulmonary complications with wound infection, 3 patients had septicemia with wound infection, 2 had septicemia with pulmonary complications. In the study done by Doeksen et al. (2007) the most common complication was of cardiovascular origin occurring in ~47% followed by COPD in ~22% patients. In the study by Koirala R, Shakya VC, Khania S, et al. (2012), the most common complication was wound infection in 32.5% patients followed by wound dehiscence in 17.5% patients, Pulmonary complications in 25%, cardiovascular complications in 15% and septicemia in 10% patients. In the study done by Sharma A, Sahu SK, Nautiyal M, et al. (2016), the most common complication was of respiratory origin followed by wound infection.
With regard to the method of annuloplasty, McCarthy and colleagues 6 concluded that TR increased over time after Peri-Guard and De Vega annuloplasty, and these techniques
should be abandoned. Other review papers have also indi- cated that ring annuloplasty is superior to De Vega annulo- plasty. 14 Given this evidence and the reproducibility of ring annuloplasty, artificial ring annuloplasty is an important surgical option for TVS. In our study, all 49 patients (42 %) who underwent TVS had tricuspid annuloplasty at the time of redosurgery. Of these, 23 (47 %) underwent an- nuloplasty using the suture technique.
Results: There were 28 patients, aged 1–12 (mean 3.8) years, with failed hypo- spadias repairs. The initial severity of the hypospadias were as follows: perineal (1), penoscrotal (9), proximal shaft (1), mid-shaft (9), distal shaft (4), coronal (3) and mega-meatus (1). Of all the patients, 24 had 1 repair, 3 had 2 repairs and 1 had 3 repairs. The initial repairs comprised 11 tubularized island flaps (TIFs), 8 Snodgrass tubularized incised plate (TIP) techniques, 5 Mathieu repairs, 1 Meatal Advancement and GlanuloPlasty Incorporated (MAGPI) technique, 1 Pyramid, 1 Arap technique and 1 Thiersch-Duplay repair. Twenty-one of 28 patients had 1 redo operation, 5 had 2 redo operations, 1 had 3 redo oper- ations and 1 had 4 redo operations, for a total of 38 redo operations. Of these, 26 were TIP techniques (68.4%), 3 were Mathieu (7.9%), 3 were TIF repairs (7.9%), 2 were onlay island flaps (5.3%) and 4 were buccal mucosal grafts (10.5%). Follow-up was 1–5 years (mean 3.5 yr). The final locations of urethral meatus included glans (18), corona (6), mid-shaft (3) and penoscrotal (1). Complications after redosurgery comprised 4 urethrocutaneous fistulae, 2 meatal stenoses, 1 urethral stricture and 3 dehiscences. Sixteen patients were followed with yearly uroflow with a Q-mean (mean uroflow) range of 3–14 mL/s (mean 8.1 mL/s).
mind, especially since an additional aspect in favour of resection of the gastroesophageal junction area, was the severe pain hypothetically related to the extensive scarring of the hiatal region. Redosurgery after fundoplication using other approaches than yet another fundoplication are rarely performed and there is no evidence supporting the use of any specific reconstruction method over the other. RNY reconstruction has been proposed as an alter- native and more effective method in patients with obesity or esophageal dysmotility [31, 32]. In addition to this, resection of the distal esophagus, cardia and proximal stomach may be indicated if symptoms of the patient include dysphagia and pain. From a theoretical point, preservation of the duodenal passage by performing a Merendino procedure could reduce post gastrectomy symptoms as compared to RNY, but the data presented here are not supportive of this.
We started performing this technique in 2010. Since then, we have moved away from inserting buccal graft in Stage I (Bracka) unless there are no options. We have performed this type of staged urethroplasty in 53 patients since 2010. Three patients had partial glans dehiscence, 2 developed urinary tract infection (UTI), and 2 had urethrocutaneous fistula. The 2 patients with UTI needed intravenous antibiotics. In 1 patient, the UTI kept recurring, and this was probably due to the presence of previous skin-lined urethra. He has been maintained on low-dose antibiotics. In patients with glans dehiscence and urethrocutaneous fistula, redosurgery was done after an interval of 6 months.
Having increased operative and technical skills and improved long-term survival after cardiac surgery, in recent years, surgeons inclined to perform redo cardiac surgery instead of medical therapy or other cardiac interventions [1, 2]. Patients with previous coronary artery bypass surgery (CABG) tend to have more complex disease (high SYNTAX scores), and morbidity is signiﬁ cantly higher with percutaneous coronary interventions . Even incomplete revas- cularization is not associated with adverse events during follow-up after CABG . Moreover, redo CABG is nearly as safe as the primary operation . Redosurgery is inevitable in patients with prosthetic heart valves that carry similar morbidity and mortal- ity compared to primary replacement . However, mortality seems as much higher as main surgery . Therefore, we intended to report the surgical out- come and determine the predictors that could inﬂ u-
Smoking also compromises the immune system, which increases the risk of a post-operative infection, slows healing, and increases your risk of pneumonia. Cigarette smoking decreases the chances of having a successful surgical outcome. Quitting before surgery will reduce all the associated risks and increase the likelihood of obtaining the best results. If you have stopped smoking, we applaud your continued efforts not to smoke. If you are currently smoking, we encourage you to stop. Please discuss with your physician for the best way for you to stop smoking. Where can I go for support?
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One copy of this report with supporting documentation, if applicable, will be mailed to the American Osteopathic Colleges of Ophthalmology and Otolaryngology-Head and Neck Surgery (AOCOO-HNS), 405 W. Grand Avenue, Dayton, Ohio 45405.
After surgery they will wake you in the Operating Room, but you will probably not remember. Then you will be moved into the Recovery Room/Post Anesthesia Care Unit (PACU) where the nurse will continue to monitor you as you awaken and manage your pain. This room may seem noisy and bright. There will be other patients in the Recovery Room/PACU.
in Cardiothoracic Surgery a vibrant meeting with an excellent scientific program and exten- sive opportunities for cross talks and inter- actions. We are doing our very best to make your stay in Bergen enjoyable and inspirational. Most welcome to Bergen!
Sleep apnea/CPAP usage: If you have sleep apnea and use CPAP, then discuss these with your surgeon before surgery. Your nasal swelling may make it difficult to use nasal masks. You may need to contact your CPAP machine provider 2 weeks before surgery and request a full face mask. Try to sleep with your head of bed elevated or in a recliner at 30-45 degrees for the first week after surgery. One must minimize the narcotics during your recovery and follow the instructions below.
Last year brought program advancements, staff additions, expanded surgical options, and well-deserved recognition of excellence in bariatric care at Munson Medical Center (MMC). Goals for each patient in the bariatric program are weight loss by improving eating behavior, preventing secondary complications of morbid obesity, reducing life-threatening factors, and increasing daily activities. Our support team, which includes a clinical coordinator or registered nurse, a psychologist, and an exercise physiologist or personal trainer, plays a vital role in our patients’ successes. Comprehensive care during the program, and lifelong follow-up after surgery, make our program among the best in the country.
Your doctor will determine whether medications for blood pressure, diabetes, etc., can be stopped when the conditions for which they are taken improve or resolves after weight loss surgery. For meds that need to be continued, the vast majority can be swallowed, absorbed and work the same as before weight loss surgery. Usually no change in dose is required. Two classes of medications that should be used only in consultation with your surgeon are diuretics (fluid pills) and NSAIDs (most over-the- counter pain medicines). NSAIDs (ibuprofen, naproxen, etc.) may create ulcers in the small pouch or the attached bowel. Most diuretic medicines make the kidneys lose potassium. With the dramatically reduced intake experienced by most weight loss surgery patients, they are not able to take in enough potassium from food to
Dumping syndrome can occur after bariatric surgery for combined or primary malabsorptive procedures. Early symptoms (within 30 minutes after eating) occur when food and fluid pass into the small intestine too fast. Symptoms might include nausea, vomiting, stomach pain or cramping, diarrhea, feelings of fullness or bloating, or increased heart rate. Late symptoms (1 to 3 hours after eating) occur when there are changes in the amounts of insulin and sugar in the blood (ie, reactive hypoglycemia). Late symptoms might also include flushing or sweating, intense need to lie down, feeling weak or dizzy, feeling nervous or shaky, or a drop in blood pressure.
Redo cardiac surgery increases mortality and morbidity. The aim of this study was to determine if aprotinin was superior to tranexamic acid concerning control bleeding loss after redo valve surgery. A retrospective study was con- ducted from January 1994 until December 2014. 221 patients underwent redo cardiac valve surgery and separated into two groups: aprotinin group (n = 85) and tranexamic acid group (n = 136). Univariate tests were applied for data analysis. A total of 221 patients were enrolled in this study. This cohort was separated into two groups: aprotinin group (n = 85) and tranexamic acid group (n = 136). Euroscore in tranexamic acid group was higher: 5.96 ± 3.04 vs. 5.17 ± 2.83 in aprotinin group (p = 0.055). There was no statistical differ- ence in postoperative mortality between the two groups (p = 0.153). No statis- tical differences were reported concerning: total blood loss (p = 0.51), red blood cells transfusion (p = 0.215), reexploration for bleeding (p = 0.537) and postoperative renal failure (p = 0.79). There were statistical differences con- cerning mechanical ventilation time, which is longer in tranexamic acid group (p = 0.008) and the use of inotropic drug support, which is more frequent in the tranexamic acid group (p = 0.001). Our results demonstrated that tra- nexamic acid and aprotinin reduce transfusion requirement and blood loss. Due to financial reason, we chose tranexamic acid in preventing blood loss in redo valve surgery.