Background-Surgical intervention is playing an increasingly important therapeutic role in congestive heart failure (CHF) patients with ischemia and dilated cardiomyopathy. Their mitral regurgitation (MR) is a result of left ventricular (LV) geometrical distortion. The optimal type of ring for CHF patients with geometric ventricular-based MR is unknown. This study reviewed the results of flexible versus nonflexible complete mitral valve rings in CHF patients with geometric mitral regurgitation. Methods and Results-Using a prospectively maintained database, patients undergoing mitral valve reconstruction (MVR) with either a flexible or nonflexible complete ring were identified on the basis of preoperative ejection fraction (EF) Յ30% and no primary mitral pathology. These 2 groups of CHF patients with severe geometric MR were then compared in terms of recurrent MR requiring reoperation. Between 1992 and 2004, 289 patients with EF Յ30%, received an undersized complete mitral annuloplasty ring as their MVR procedure. Of these, 170 patients had a flexible complete ring. In follow-up, 16 "flexible" patients (9.4%) required a repeat procedure for significant recurrent geometric MR and CHF (10 replacements, 3 re-repairs, 3 transplants). The average time to reoperation was 2.4 years. In contrast, 119 patients with an EF Յ30% received a MVR using an undersized nonflexible complete ring. Only 3 "non-flexible" patients required a repeat operation, MVR (1), and 2 patients required a transplant. The time to reoperation was 4.0 years. A significant difference in reoperation rates, for recurrent MR, between the 2 groups (Pϭ0.012). There were no differences between groups, in terms of age, ring size used, preoperative EF, LV size, MR grade, or New York Heart Association class.
Conclusions-Patients
Cardiac surgery patients ICU length of stay(LOS) had increased since moving to a larger, 24 bed unit in the Cardiovascular building. This resulted in a reduction from 45% to 26% of patients being weaned post‐op in a 6 hour period. Longer delays in weaning post cardiac surgery patients off the ventilator, particularly routine Cardiac bypass and valve replacement/repair patients was found to increase overall LOS and a reduced ability to perform more surgeries. After collecting data indentifying the sources of these delays, we set out to reduce the time these patients were vented. Nursing staff and Respiratory therapists developed protocols and guidelines and then educated and trained staff to initiate these protocols with a 6 hour goal for each patient. Using these education tools and this new RT/RN extubation protocol we have been able to reduce ventilator time to pre‐CVC levels, opening more beds and availabilty to perform more surgeries.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.