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  • 1.
    Deb, Saswata
    et al.
    Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
    Singh, Steve K.
    Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
    de Souza, Domingos Ramos
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Cardiothoracic and Vascular Surgery.
    Chu, Michael W. A.
    Department of Surgery, Western University, London Health Sciences Centre, London, Canada.
    Whitlock, Richard
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Meyer, Steven R.
    Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada.
    Verma, Subodh
    St. Michael's Hospital, Toronto, Canada.
    Jeppsson, Anders
    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Al-Saleh, Ayman
    McMaster University, Hamilton, Canada.
    Brady, Katheryn
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Rao-Melacini, Purnima
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Belley-Cote, Emilie P.
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Tam, Derrick Y.
    Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
    Devereaux, P. J.
    Population Health Research Institute, McMaster University and Hamilton Health Sciences, Hamilton, Canada.
    Novick, Richard J.
    University of Calgary and Foothills Medical Centre, Calgary, Canada.
    Fremes, Stephen E.
    Sunnybrook Health Sciences Centre, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
    SUPERIOR SVG: no touch saphenous harvesting to improve patency following coronary bypass grafting (a multi-Centre randomized control trial, NCT01047449)2019Inngår i: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 14, nr 1, artikkel-id 85Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Single centre studies support No Touch (NT) saphenous vein graft (SVG) harvesting technique. The primary objective of the SUPERIOR SVG study was to determine whether NT versus conventional (CON) SVG harvesting was associated with improved SVG patency 1 year after coronary artery bypass grafting surgery (CABG).

    METHODS: Adults undergoing isolated CABG with at least 1 SVG were eligible. CT angiography was performed 1-year post CABG. Leg adverse events were assessed with a questionnaire. A systematic review was performed for published NT graft patency studies and results aggregated including the SUPERIOR study results.

    RESULTS: Two hundred and-fifty patients were randomized across 12-centres (NT 127 versus CON 123 patients). The primary outcome (study SVG occlusion or cardiovascular (CV) death) was not significantly different in NT versus CON (NT: 7/127 (5.5%), CON 13/123 (10.6%), p = 0.15). Similarly, the proportion of study SVGs with significant stenosis or total occlusion was not significantly different between groups (NT: 8/102 (7.8%), CON: 16/107 (15.0%), p = 0.11). Vein harvest site infection was more common in the NT patients 1 month postoperatively (23.3% vs 9.5%, p < 0.01). Including this study's results, in a meta-analysis, NT was associated with a significant reduction in SVG occlusion, Odds Ratio 0.49, 95% Confidence Interval 0.29-0.82, p = 0.007 in 3 randomized and 1 observational study at 1 year postoperatively.

    CONCLUSIONS: The NT technique was not associated with improved patency of SVGs at 1-year following CABG while early vein harvest infection was increased. The aggregated data is supportive of an important reduction of SVG occlusion at 1 year with NT harvesting.

    TRIAL REGISTRATION: NCT01047449 .

  • 2.
    Jonsson, Marcus
    et al.
    Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic surgery, Örebro University Hospital, Örebro, Sweden.
    Urell, Charlotte
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Emtner, Margareta
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskap och medicin. Region Örebro län. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden; Department of Cardiothoracic surgery, Örebro University Hospital, Örebro, Sweden.
    Self-reported physical activity and lung function two months after cardiac surgery: a prospective cohort study2014Inngår i: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 9, artikkel-id 59Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Physical activity has well-established positive health-related effects. Sedentary behaviour has been associated with postoperative complications and mortality after cardiac surgery. Patients undergoing cardiac surgery often suffer from impaired lung function postoperatively. The association between physical activity and lung function in cardiac surgery patients has not previously been reported.

    Methods: Patients undergoing cardiac surgery were followed up two months postoperatively. Physical activity was assessed on a four-category scale (sedentary, moderate activity, moderate regular exercise, and regular activity and exercise), modified from the Swedish National Institute of Public Health's national survey. Formal lung function testing was performed preoperatively and two months postoperatively.

    Results: The sample included 283 patients (82% male). Two months after surgery, the level of physical activity had increased (p < 0.001) in the whole sample. Patients who remained active or increased their level of physical activity had significantly better recovery of lung function than patients who remained sedentary or had decreased their level of activity postoperatively in terms of vital capacity (94 +/- 11% of preoperative value vs. 91 (+/-) 9%; p = 0.03), inspiratory capacity (94 +/- 14% vs. 88 +/- 19%; p = 0.008), and total lung capacity (96 +/- 11% vs. 90 +/- 11%; p = 0.01).

    Conclusions: An increased level of physical activity, compared to preoperative level, was reported as early as two months after surgery. Our data shows that there could be a significant association between physical activity and recovery of lung function after cardiac surgery. The relationship between objectively measured physical activity and postoperative pulmonary recovery needs to be further examined to verify these results.

  • 3.
    Larsson, Hanna
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Cardiothoracic and Vascular Surgery.
    Hälleberg Nyman, Maria
    Örebro universitet, Institutionen för hälsovetenskaper.
    Friberg, Örjan
    Department of Cardiothoracic and Vascular Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Falk-Brynhildsen, Karin
    Örebro universitet, Institutionen för hälsovetenskaper.
    Perioperative routines and surgical techniques for saphenous vein harvesting in CABG surgery: a national cross-sectional study in Sweden2020Inngår i: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 15, nr 1, artikkel-id 5Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients' risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons.

    METHODS: A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden.

    RESULTS: Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, "no-touch" by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres.

    CONCLUSIONS: In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.

  • 4.
    Urell, Charlotte
    et al.
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden.
    Emtner, Margareta
    Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden; Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden.
    Hedenström, Hans
    Department of Medical Sciences, Clinical Physiology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden.
    Westerdahl, Elisabeth
    Örebro universitet, Institutionen för hälsovetenskaper. Department of Medical Sciences, Clinical Physiology, Uppsala University, Akademiska sjukhuset, Uppsala, Sweden; UFC, Region Örebro County, Örebro, Sweden.
    Respiratory muscle strength is not decreased in patients undergoing cardiac surgery2016Inngår i: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, artikkel-id 41Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Postoperative pulmonary impairments are significant complications after cardiac surgery. Decreased respiratory muscle strength could be one reason for impaired lung function in the postoperative period. The primary aim of this study was to describe respiratory muscle strength before and two months after cardiac surgery. A secondary aim was to describe possible associations between respiratory muscle strength and lung function.

    Methods: In this prospective observational study 36 adult cardiac surgery patients (67 ± 10 years) were studied. Respiratory muscle strength and lung function were measured before and two months after surgery.

    Results: Pre- and postoperative respiratory muscle strength was in accordance with predicted values; MIP was 78 ± 24 cmH2O preoperatively and 73 ± 22 cmH2O at two months follow-up (p = 0.19). MEP was 122 ± 33 cmH2O preoperatively and 115 ± 38 cmH2O at two months follow-up (p = 0.18). Preoperative lung function was in accordance with predicted values, but was significantly decreased postoperatively. At two-months follow-up there was a moderate correlation between MIP and FEV1 (r = 0.43, p = 0.009).

    Conclusions: Respiratory muscle strength was not impaired, either before or two months after cardiac surgery. The reason for postoperative lung function alteration is not yet known. Interventions aimed at restore an optimal postoperative lung function should focus on other interventions then respiratory muscle strength training.

  • 5.
    Westerdahl, Elisabeth
    et al.
    Örebro universitet, Institutionen för hälsovetenskaper.
    Jonsson, Marcus
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Emtner, Margareta
    Department of Medical Sciences, Respiratory Medicine and Allergology, Uppsala University, Uppsala, Sweden.
    Pulmonary function and health-related quality of life 1-year follow up after cardiac surgery2016Inngår i: Journal of Cardiothoracic Surgery, ISSN 1749-8090, E-ISSN 1749-8090, Vol. 11, nr 1, artikkel-id 99Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Pulmonary function is severely reduced in the early period after cardiac surgery, and impairments have been described up to 4-6 months after surgery. Evaluation of pulmonary function in a longer perspective is lacking. In this prospective study pulmonary function and health-related quality of life were investigated 1 year after cardiac surgery.

    Methods: Pulmonary function measurements, health-related quality of life (SF-36), dyspnoea, subjective breathing and coughing ability and pain were evaluated before and 1 year after surgery in 150 patients undergoing coronary artery bypass grafting, valve surgery or combined surgery.

    Results: One year after surgery the forced vital capacity and forced expiratory volume in 1 s were significantly decreased (by 4-5 %) compared to preoperative values (p < 0.05). Saturation of peripheral oxygen was unchanged 1 year postoperatively compared to baseline. A significantly improved health-related quality of life was found 1 year after surgery, with improvements in all eight aspects of SF-36 (p < 0.001). Sternotomy-related pain was low 1 year postoperatively at rest (median 0 [min-max; 0-7]), while taking a deep breath (0 [0-4]) and while coughing (0 [0-8]). A more pronounced decrease in pulmonary function was associated with dyspnoea limitations and impaired subjective breathing and coughing ability.

    Conclusions: One year after cardiac surgery static and dynamic lung function measurements were slightly decreased, while health-related quality of life was improved in comparison to preoperative values. Measured levels of pain were low and saturation of peripheral oxygen was same as preoperatively.

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