Cardioprotective effect of propofol in cardioplegia compared to systemic propofol in heart valves surgery; a randomized controlled trialCARDIOTHORACIC SURGEON - Tập 31 - Trang 1-10 - 2023
Amr Atef Attia, Mohammad Abd Elmoneim Torky, Mohamed Mahmoud Abo Elnasr, Ehab Abd Elmonem Wahby, Abd Elhady Mohammed Taha
Myocardial protection is still a focus of ongoing research. Propofol is used widely during the induction of anaesthesia in cardiac surgery. So, this triggers us to investigate the cardioprotective effect of the propofol when added to the cardioplegia compared to systemic propofol by measuring the troponin T level. This clinical randomized controlled trial was carried out on 150 patients operated for elective valvular heart surgery. Patients were assigned into three equal groups: Group 1: received propofol in the cardioplegia, Group 2: received propofol injection in the aortic line before and after the aortic cross-clamp, and Group 3 (control group): patients without propofol in the cardioplegia or aortic line. All patients were subjected to full medical histories, physical examinations, routine tests, and echocardiography. Cardiac troponin T was measured before surgery and 4 times postoperatively. In group 1, there was a significant improvement in troponin T level at the last reading compared with the control group (mean ± SD. of group 1 was 246.4 ± 131.4, mean ± SD. of group 3 was 317.0 ± 117.9, p = 0.031), denoting propofol's cardioprotective effect when added as a cardioplegia additive. In group 2, there was a significant improvement of troponin T level at the last reading compared with the group 1 and control group (mean ± SD. of group 2 was 202.54 ± 156.03, mean ± SD. of group 3 was 317.0 ± 117.9, p < 0.001), denoting propofol's more cardioprotective effect when used systemically during cardiopulmonary bypass than when added as a cardioplegia additive. In valvular cardiac surgery, propofol has an additional cardioprotective effect and a superior cardiac outcome when administered systematically during cardiopulmonary bypass rather than added to cardioplegia. Pan African Clinical Trials Register PACTR201907764652028. Registered on 01 July 2019, retrospectively registered,
https://pactr.samrc.ac.za/
TrialDisplay.aspx?TrialID = 5726.
Index of deterioration of patients with mechanical prosthetic heart valve thrombosisCARDIOTHORACIC SURGEON - Tập 28 Số 1 - 2020
Ahmed Hassouna, Mohamed A Elghanam, Hassan Moftah, Khaled Samir, Khaled Refaat
Abstract
Background
Mechanical prosthetic heart valves are known for their durability; however, a malfunctioning prosthesis can deteriorate rapidly to become a life-threatening complication. Our aim was to calculate a numerical index to express the rate of clinical deterioration of patients presenting with a mechanical prosthetic heart valve thrombosis (PVT), called the index of deterioration (ID), and to evaluate its usefulness in predicting hospital outcomes.
Results
The median ID and range were (0.43, 0.03-3) NYHA class/day. A higher ID was significantly related to early development of PVT after native valve replacement, younger age, female gender, pregnancy, non-compliance to oral anticoagulation (OAC), low LVEF%, high mean pressure gradient across a mitral prosthesis, raised serum creatinine, and SGOT on admission (P < 0.05). Independent predictors were early presentation after native valve replacement, female gender, and non-compliance to OAC (P < 0.05).
ID correlated positively with the need for urgent/emergency surgery, and the durations of cardiopulmonary bypass, postoperative mechanical ventilation, and positive inotropes. ID correlated negatively with the postoperative LVEF% (P < 0.05). Median ID of the 21 mortalities (0.75, 0.1-3) was > 2.1 times that of survivors (0.35: 0.03−2; P = 0.002), and the median ID of the 29 cases with postoperative complications (0.5, 0.1-1.5) was 2.5 times that of the 39 uneventful cases (0.2, 0.03-2; P = 0.011). The ID significantly predicted both mortality (odds ratio 3.87; 1.33-1.29; P = 0.013) and mortality and hospital complications (odds ratio 4.77; 1.49-15.2; P = 0.008). The respective discriminating abilities were AUC 0.734 (0.616-0.852; P = 0.002) and 0.724 (0.61-0.835; P < 0.001). EuroScore II correlated positively with ID (r = 0.571; P < 0.001) but showed better discriminative abilities.
Conclusion
The simple index of deterioration was useful in monitoring deterioration and predicting hospital progression and outcomes in patients presenting with PVT.
The effect of hyperlactatemia timing on the outcomes after cardiac surgeryCARDIOTHORACIC SURGEON - Tập 28 - Trang 1-8 - 2020
Khaled D. Algarni
Several studies linked postoperative hyperlactatemia to worse outcomes in adult patients undergoing cardiac surgery. However, data on the effect of timing of hyperlactatemia on outcomes are scarce. We sought to determine the prevalence of early hyperlactatemia (EHL) and its impact on clinical outcomes compared to late hyperlactatemia (LHL) in patients undergoing ACS procedures. We included 305 consecutive adult patients who underwent cardiac surgery procedures between July 2017 and Nov 2019 at a single institution. Lactate level was measured in the first 10 h after surgery and EHL was defined as lactate level > 3 mmol/L in the first hour after surgery. Logistic regression analysis was performed to determine predictors of EHL. Seventeen percent (n = 52) had EH while 83% (n = 253) did not. Patients with EHL had significantly longer cardiopulmonary bypass (P = 0.001) and cross-clamp (P = 0.001) times due to increased surgical complexity in this group. Early hyperlactatemia was associated with increased post-operative extracorporeal membrane oxygenation (ECMO) support (0% vs 5.7%, P < 0.001), longer intensive care unit stay (P = 0.004), and increased hospital mortality (0% vs. 3.8%, P = 0.009). Cardiopulmonary bypass time (OR 1.001; 95% CI 1.011–1.012, P = 0.02) and glucose level (OR 1.2; 95% CI 1.1–1.3, P = 0.003) were independently associated with increased rate of EHL. In contrast, diabetes mellitus (OR 0.26; 95% CI 0.12–0.55, P < 0.001) significantly attenuated the rate of EHL. Early hyperlactatemia after cardiac surgery was associated with increased morbidity and mortality. Late hyperlactatemia was very common and had a self-limiting and benign course.
Balloon tracheoplasty for tracheal stenosis after prolonged intubation: a simple procedure, but is it effective?CARDIOTHORACIC SURGEON - Tập 29 - Trang 1-7 - 2021
Abdallah Nosair, Mahmoud Singer, Mohamed Elkahely, Rezk Abu-Gamila, Waleed Adel
Tracheal stenosis following prolonged intubation is a relatively rare but serious problem. This condition is usually managed by surgical or endoscopic interventions. Bronchoscopic balloon dilatation for tracheal stenosis is considered a valuable tool used for the management of tracheal stenosis. In this article, we try to evaluate the role of balloon tracheoplasty in the management of tracheal stenosis and to assess the number of dilatation sessions usually needed as well as the short to midterm outcome. This study involved 40 patients with tracheal stenosis diagnosed by computed tomography (neck and chest) and bronchoscopy at the Security Force Hospital in Riyadh, KSA, between January 2013 and August 2018. Patients’ data were retrospectively reviewed and analyzed. Patients’ age ranged between 18 and 60 years. Thirty patients were males (75%); those patients underwent balloon tracheoplasty via dilatation of areas of narrowing using catheter balloon insufflation guided by fiber-optic bronchoscope. Ninety-five percent of the patients had initial success with acceptable dilatation of the stenotic area and improvement of the symptoms. There were no technical or major problems which resulted from the procedure, and no patient complained of severe pain or severe discomfort after the procedure. From the total of 81 BBD sessions, no in-hospital mortality is related to the procedure itself, and ICU stay ranged between 1 and 5 days post-procedure. Among those 40 patients, 16 patients (40%) needed one session, 10 patients (25%) needed two sessions, 8 patients (20%) needed three sessions, and 6 patients (15%) needed more than three sessions of balloon dilatation. Balloon tracheoplasty is a simple, safe method and could be a promising and effective approach that offers immediate symptomatic relief for tracheal stenosis in cases with a history of prolonged intubation. It is worth mentioning that BBD is considered as a temporary measure, and most of the cases will need definitive or additional treatment either resection or stent placement.
Primary versus staged repair of Fallot with borderline pulmonary artery anatomyCARDIOTHORACIC SURGEON - Tập 27 - Trang 1-5 - 2019
Basem M. Abdelgawad, Mahmoud A. Elshafie, Suzan Bayoumy, Elatafy E. Elatafy
Surgical management of tetralogy of Fallot (TOF) can be either with a total primary repair or staged repair. The superiority of one technique over the other is still debatable, especially in developing countries with late presentation and limited resources. The objective of this study was to compare the outcome of patients with tetralogy of Fallot and borderline pulmonary anatomy defined as McGoon ratio between 1.2 and 1.6 who underwent primary versus staged repair. The patients were divided into two groups: group A included patients who underwent primary repair (n = 120) and group B included patients who underwent repair after previous modified Blalock-Taussig (MBT) shunt operation (n = 100). Patients in group B were significantly older (11 ± 2.6 vs. 7 ± 3.1 months; p < 0.001) and had higher McGoon ratio (1.61 ± 0.07 vs. 1.5 ± 0.08; p < 0.001). In group B, the total operative time (277 ± 21.3 vs. 232 ± 24.6 min; p < 0.001), cardiopulmonary bypass time (81 ± 13.7 vs. 60 ± 11.2 min; p < 0.001), and ischemic time (64 ± 12 vs. 53 ± 7.1 min; p < 0.001) were significantly higher. There was no difference in postoperative complications between both groups. In-hospital mortality was nine patients (7.5%) in group A and 6 (6%) in group B (p = 0.791). Primary repair of tetralogy of Fallot in patients with borderline McGoon ratio is safe with low morbidity and mortality. It has the potential of decreasing hospital stay, cost, and resource utilization of the two-stage repair.
Heart recovery and reverse remodeling following lung transplant in pulmonary artery hypertensionCARDIOTHORACIC SURGEON - Tập 30 - Trang 1-6 - 2022
Hussain Alshimali, Antonio Coppolino, Mohamed A. Keshk, John S. Young, Akinobu Itoh, Hilary J. Goldberg, Nirmal S. Sharma, Hari R. Mallidi
Pulmonary artery hypertension (PAH) is a progressive disease that result in right heart dysfunction. Lung transplantation (LTx) improve survival in end-stage disease. The aim of this study is to assess heart recovery after LTx for patients with primary and secondary pulmonary hypertension. We conducted a single center retrospective review for patients with primary and secondary PAH underwent LTx between the period of January 2015 and December 2020. Baseline characteristics and echocardiographic measures were assessed pre-operative and after 1 year follow-up. Survival comparison between primary and secondary PAH was estimated by Kaplan–Meier method. We identified 43 participants for the study. Among the participants, 11 case had primary PAH. Median age during transplant was 60 years (45.5, 65.5). Left atrium anterio-posterior dimensions, systolic right ventricle pressure tricuspid peal regurgitant velocity and severity of tricuspid regurgitation were found to be significantly improved post-operatively compared to pre-operative echocardiography (p value < 0.05). Overall mortality was not significant between primary and secondary PAH (p value = 0.66). LTx can reverse heart remodeling and facilitate recovery in primary and secondary PAH. Our data confirm the importance of LTx as a viable option in PAH failing medical treatment.
Khiếm khuyết vách ngăn nhĩ thất từng phần trong bốn gia đình có liên quan: loạt trường hợp và tổng quan tài liệu Dịch bởi AI CARDIOTHORACIC SURGEON - Tập 30 - Trang 1-4 - 2022
Sameh Alagha, Ferit Çiçekçioğlu, Veysel Başar, Zafer Cengiz ER
Khiếm khuyết vách ngăn nhĩ thất là các khiếm khuyết tim bẩm sinh phổ biến và bao gồm một phổ những bất thường, những khiếm khuyết này đã được mô tả trong một vài gia đình gợi ý về mô hình di truyền gia đình, và chúng thường gặp hơn ở những bệnh nhân có bất thường nhiễm sắc thể. Sự xuất hiện trong gia đình của loại bệnh tim bẩm sinh đặc biệt này là không phổ biến và có rất ít trường hợp đã được xác định là khiếm khuyết vách ngăn nhĩ thất từng phần ở người lớn, bên cạnh các bất thường nhiễm sắc thể khác. Chúng tôi báo cáo bốn trường hợp nữ giới trưởng thành được chẩn đoán mắc khiếm khuyết vách ngăn nhĩ thất từng phần trong bốn gia đình có liên quan, bệnh nhân của chúng tôi không có hình thái của hội chứng Down. Nghiên cứu thêm về genotyping những bệnh nhân này có thể góp phần vào kiến thức của chúng ta về sự dị tật tim đặc biệt này.
#Khiếm khuyết vách ngăn nhĩ thất #bất thường tim bẩm sinh #di truyền gia đình #hội chứng Down #genotyping.
Pediatric precision: navigating the complexity of mycotic pseudoaneurysms in ascending aorta post-atrial septal defect repair—a case reportCARDIOTHORACIC SURGEON - Tập 32 - Trang 1-4 - 2024
Anand Shankar Soundararajan, Aishwarya Pandiyan, Ezhilnambi Sundaramoorthy, Kathirvel Balasubramani, H. R. Haroon Shakir, G. K. Jaikaran
This case report elucidates the exceptional rarity and intricacies surrounding mycotic pseudoaneurysms in the ascending aorta, specifically post-pediatric cardiac surgery. The case report presents a distinctive case of a 7-year-old female developing complications 10 days after atrial septal defect repair, characterized by sternal wound infection attributed to Pseudomonas aeruginosa. Imaging revealed a substantial pseudoaneurysm, necessitating a meticulous surgical strategy involving femoral cannulation, redo sternotomy, and adept management of intraoperative challenges, such as a fragile sternum and dense adhesions. The successful postoperative course, marked by weaning and comprehensive management, contributes significant insights into the evolving landscape of mycotic pseudoaneurysms in pediatric populations. The discussion delves into the historical context, mechanisms, and causative organisms, emphasizing the heightened vigilance required in the postoperative care of this vulnerable demographic. This report enhances our understanding of pediatric cases, underscoring the imperative for increased awareness and strategic management in addressing post-cardiac surgery complications.
Predictors of perioperative myocardial infarction in patients undergoing off-pump coronary artery bypass graftingCARDIOTHORACIC SURGEON - Tập 30 Số 1 - 2022
Mohamed A. Amr, Elsayed A Fayad
Abstract
Background
Perioperative myocardial infarction (PMI) increases morbidity and mortality after off-pump coronary artery bypass grafting (CABG). The objective of the current study was to characterize patients with PMI after off-pump CABG and identify its predictors.
Results
We included 1181 patients who had off-pump CABG from 2010 to 2020; 59 patients (5%) had PMI. We compared patients with PMI to those without PMI. Patients with PMI were older (57 (25th–75th percentiles: 51–63) vs. 54 (48–60) years; P = 0.01) and had higher NYHA class (28 (47.46%) vs. 326 (29.06%): P = 0.01). The distal anastomosis time was longer in patients with PMI (28 (23–35) vs. 24 (16–30) min; P ˂ 0.001). Patients with PMI had higher postoperative low cardiac output (10 (18.18%) vs. 1 (0.1%): P ˂ 0.001), prolonged ventilation (12 (8–39) vs. 8 (6–10) h, P ˂ 0.001), ICU (71 (46–138) vs. 24 (23–42) h; P ˂ 0.001), and hospital stay (9 (6–15) vs. 7 (6–8) days; P ˂ 0.001). Mortality was significantly higher in patients with PMI (20 (33.9%) vs. 6 (0.53%); P ˂ 0.001). Older age (OR: 1.05 (95% CI: 1.01–1.1); P = 0.02), increased number of distal anastomoses (OR: 1.74 (95% CI: 1.20–2.50); P = 0.003), preoperative congestive heart failure (OR: 10.27 (95% CI: 2.58–40.95); P = 0.001), and thrombolysis within 24 h of surgery (OR: 15.34 (1.93–121.9); P = 0.01) were associated with increased PMI, while PMI was lower in male patients (OR: 0.42 (95% CI: 0.19–0.93); P = 0.03) and with higher body surface area (BSA) (OR: 0.08 (95% CI: 0.07–0.86); P = 0.04).
Conclusions
Post-off-pump CABG PMI was associated with increased morbidity and mortality. Risk factors for PMI were older age, lower BSA, females, increased distal anastomoses, preoperative heart failure, and thrombolysis.
