No description available.

No description available.

Patients with chronic kidney disease (CKD) are a group with a markedly increased risk of adverse events following cardiac surgery. A particular problem for these patients is the development of post-operative acute kidney injury (AKI), which is associated with a significant increase in morbidity and mortality. Currently, there are no effective therapies proven to modify AKI in patients undergoing cardiac surgery. This thesis has three parts. The first describes an analysis of the Barts Health NHS Trust cardiac surgical dataset. Specifically, outcomes of patients with CKD and AKI were examined. The second describes a randomized control trial that examined the effect of remote ischaemic preconditioning (RIPC) upon AKI and myocardial injury in patients with CKD undergoing coronary artery bypass graft surgery (CABG). The final part describes the development of a panel of AKI biomarkers to allow the accurate prediction of AKI in patients with CKD undergoing CABG. The aims of this thesis were: 1. In our local cardiac surgical cohort, a. To assess the effects of CKD upon outcomes after CABG. b. To asses the prognostic importance of AKI after CABG. 2. To assess the potential for RIPC to reduce AKI and myocardial injury in patients with CKD undergoing CABG. 3. To investigate the diagnostic performance of serum and urine AKI biomarkers in a population of patients with CKD undergoing CABG. Analysis of the Barts Health NHS Trust cardiac surgical dataset confirmed that patients with CKD account for almost one-third of patients undergoing CABG. However, these patients account for a disproportionate two-thirds of all early mortality. CKD was also independently associated with late mortality after CABG. AKI was common in these patients. AKI was associated with late mortality even after accounting for pre-operative comorbidity and surgical complexity. In the randomized control trial, RIPC showed no effect upon the incidence of AKI or myocardial injury in the. 86 patients with CKD recruited. Secondary analysis of serum and urine biomarkers collected found change in serum cystatin C and NGAL as impressive predictors of AKI in patients with CKD. They allowed accurate early prediction of AKI more than 24 hours before diagnosis was possible using serum creatinine.

published_or_final_version / Public Health / Master / Master of Public Health

No description available.

Thesis (M.S.)--University of Michigan, 1990.

Thesis (M.S.)--University of Michigan, 1990.

The survival data for two hundred patients who underwent coronary bypass surgery are subjected to quantitative analysis. The questions of interest are: (i) the long-term survival rates of these patients, (ii) the prognostic factors influencing survival, and (iii) the importance of types of grafting in long-term survival. Statistical methods used to ascertain the important prognostic variables include contingency table analysis and discriminant analysis. It is found that left ventricular function, age, risk classification, and extent of occlusion of the diseased artery are the most influential variables. The relationship of these variables to survival is analysed in detail using the proportional hazards model discussed by Cox (1972). / Science, Faculty of / Statistics, Department of / Graduate

This descriptive study was designed to investigate the problem of inadequate emotional recovery from open heart surgery. This problem has been defined by a number of earlier researchers who have noted adverse emotional reactions to the experience of cardiac surgery in both the early postoperative and the post-discharge periods. This investigation had as its purpose the examination of the pre-discharge recovery of patients, and the investigator intended to note whether there existed a common pattern of recovery among the patients studied (hence, a pattern of emotional response to surgery). It was anticipated that the discovery of similarities of behaviour might give insight into the responses to open heart surgery and provide information important to the study of long-term rehabilitation. Twenty adult patients scheduled for open heart surgery were selected as the sample for study. The principal setting for the investigation was the Cardiac Surgery Unit of a large metropolitan hospital. Subjects were interviewed one to two days prior to surgery and then every two to three days postoperatively until the time of discharge. The investigator obtained qualitative data with the aid of a data collection tool, noting the physiological status of the subjects but focusing most directly on verbal and nonverbal behaviours exhibited. The latter observations included focus of conversation, patterns of communication, affect, orientation, level of anxiety, and activity. Following analysis of the data, it was noted that a common pattern of recovery was indeed evident. Three phases of recovery - Somatic, Transition and Resolution - could be described for each subject in the sample. The phases indicated the subjects' general responses to surgery and their progression toward increased activity and independence at the time of discharge. In effect, the phases served to define the hospital course of emotional recovery from open heart surgery. The length and onset of these three phases were similar for patients with an uncomplicated recovery but varied with patients who experienced major physiologic difficulties. The implications of a recovery pattern have been discussed relative to nursing care of the cardiac surgical patient and specific recommendations for nursing intervention have been made. Subject areas worthy of further investigation have been enumerated by the investigator in light of the conclusions of the present study. / Applied Science, Faculty of / Nursing, School of / Graduate

The outcome of 121 children who underwent palliative cardiac surgery at the Red Cross War Memorial Children's Hospital over a 5 year period, 1980 1984, was retrospectively examined. 79 children had systemic artery to pulmonary artery shunt operations (SPS), 40 had pulmonary artery bands (PAB) and 2 had surgical septectomies. SPS was most often done for children with Tetralogy of Fallot (TOF, 26 cases) or complex univentricular hearts with right ventricular outflow tract obstruction (27 cases). PAB was done chiefly for ventricular septa! defects, alone (VSD, 8 cases) or with coarctation of the aorta (9 cases). Children were referred from a wide area with 63 cases being referred from other major centres and foreign countries. Overall, 36 children died (30 % mortality): 5 died at surgery, 6 within 48 hours of surgery, a further 5 within 31 days; and 20 died after 31 days. SPS and PAB had the same early mortality rates ( 13 % ) • SPS had higher late and overall mortality rates (20 and 33 %) than PAB (10 and 23 %). Age at operation was found to be the most significant determinant of the overall mortality rate: children less than six months had a mortality of 42 % and those over 6 months, 13 % • The children were grouped into those with lesions which were probably correctable and those that were unlikely to be so, based on diagnosis and age at surgery: those with correctable lesions had a lower overall mortality (22 %) than those with uncorrectable lesions (43 %). Where the surgery was performed as an emergency, there was a higher overall and early mortality (55 and 35 respectively), compared to those operations which were performed electively ( 25 and 9 % ) • The presence of other medical conditions, for example congenital abnormalities and infections, was also a determinant of death (44 % mortality if other medical condition present, 26 % if absent). sex, population group, home address and type of surgery performed did not significantly affect mortality when examined by multivariate analysis. Using routine methods of follow up, it was initially thought that 17 % of all patients (22 % of survivors) were lost to follow up. An important determinant of this was the referral centre. 31 % of cases from other major centres and 20 % of foreign cases were lost, as compared to 8 % of cases from smaller towns near Cape Town and 2 % of children from Cape Town. Population group (35 % Blacks, 14 % Coloureds and 7 % Whites were lost), and palliative operation (23 % SPS, and 5 % PAB lost) were also significant determinants. It was possible to trace 12 of the 20 children who were thought to be lost to follow. 8 had died, 3 were still awaiting correction and 1 was traced and received corrective surgery. The records of the children who underwent cardiac surgery in 1987 were also analysed. There was no difference in the demographic characteristics of either group, and the early mortality was the same. This study shows that the outcome after palliative cardiac surgery is poor, with a high mortality rate and children often being lost to follow up. The decision to palliate rather than to correct a congenital heart defect must be made after balancing these risks with those of early correction for the particular surgical team. Should palliative surgery be undertaken, careful follow up is essential to ensure that complications of palliation do not set in and that corrective surgery is done at the optimal time.