Analysis of the problem of surgical pain is important in view of the fact that the success of surgical treatment depends largely on proper pain management during the first few days after a cardiosurgical procedure. Postoperative pain is due to intraoperative damage to tissue. It is acute pain of high intensity proportional to the type of procedure. The pain is most intense during the first 24 hours following the surgery and decreases on subsequent days. Its intensity is higher in younger subjects than elderly and obese patients, and preoperative anxiety is also a factor that increases postoperative pain. Ineffective postoperative analgesic therapy may cause several complications that are dangerous to a patient. Inappropriate postoperative pain management may result in chronic pain, immunosuppression, infections, and less effective wound healing. Understanding and better knowledge of physiological disorders and adverse effects resulting from surgical trauma, anesthesia, and extracorporeal circulation, as well as the development of standards for intensive postoperative care units are critical to the improvement of early treatment outcomes and patient comfort.

/pdf/assessment-and-pathophysiology-of-pain-in-cardiac-surgery-4lux5895t3.pdf

Assessment and pathophysiology of pain in cardiac surgery.

Medical versus medical and surgical treatment for brucella endocarditis.

Long-term quality of life improvement after transcatheter aortic valve implantation

Summary

Background

Percutaneous approach techniques with closure device after transcatheter aortic valve implantation (TAVI) have diminished vascular complications (VC). In this retrospective study, we will report incidence and angiographic factors predisposing to major VC in patients undergoing TAVI using Prostar® XL closure device as a default strategy.



Methods

Consecutive patients, who underwent TAVI transfemorally using Prostar® XL, were evaluated for the incidence of VC according to VARC criteria. Using arterial angiography, the femoral-iliac arterial tortuosity was adjusted for large arterial diameters and expressed as the ratio total tortuosity/arterial diameter (TT/AD). Arterial calcification, the combination of angulation and atheromatosis at the puncture site and ideal puncture were evaluated too. In all patients, 30 days of follow-up was available.



Results

Eighty-four patients (80.2 ± 5.86 years, 39 males [46.4%]), who were consecutively treated with the transfemoral approach, were evaluated. In patients with major VC (17/84 [20.23%]) comparing to those without, arterial calcification (11 [64.7%] vs. 8 [11.9%], P < 0.01) and the TT/AD (30.2 ± 11.25 vs. 22.06 ± 8.64, P < 0.01) were independent predictors. Ideal puncture was achieved more frequently among patients without VC comparing to those with major (94.1% vs. 70.6%, P = 0.01). Blood transfusions (1.48 ± 0.37 vs. 2.45 ± 0.59, P = 0.023) were more frequent among patients with major VC. Finally, minimum creatinin clearance after TAVI predicted all-cause 30-day mortality (P = 0.021).



Conclusions

Major VC after TAVI with the use of Prostar closure device can be predicted by arterial calcification at the puncture site and TT/AD ratio. Minimum creatinin clearance after TAVI predicted 30-day mortality.

https://www.onlinelibrary.wiley.com/doi/pdf/10.1111/1755-5922.12023

Predictive Factors of Vascular Complications after Transcatheter Aortic Valve Implantation in Patients Treated with a Default Percutaneous Strategy

Address for reprints

Transcatheter aortic valve implantation, patient selection process and procedure: two centres' experience of the intervention without general anaesthesia.

Cardio-anesthesiology considerations for the trans-catheter aortic valve implantation (TAVI) procedure

https://www.internationaljournalofcardiology.com/article/S0167-5273(07)01045-5/pdf

Valve replacement for Brucella endocarditis: Two case reports

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Papers

Transcatheter aortic valve implantation, patient selection process and procedure: two centres' experience of the intervention without general anaesthesia.

Cardio-anesthesiology considerations for the trans-catheter aortic valve implantation (TAVI) procedure

Valve replacement for Brucella endocarditis: Two case reports