We report a case of a 53 year-old man with a history of hypertension presenting with acute left lower extremity parasthesias and pulselessness initially presumed to be secondary to arterial thrombosis or embolism. Work-up included a transthoracic echocardiogram which revealed an aortic dissection at the level of the aortic root extending to the visualized portions of the descending aorta. Type A aortic dissections are relatively rare, with the vast majority of patients presenting with chest pain. Timely diagnosis of Type A aortic dissections are critical as to facilitate rapid surgical repair. To our knowledge, this is the first report of a painless Type A aortic dissection presenting with isolated lower extremity vascular insufficiency and demonstrates the potential role of transthoracic echocardiography as a rapid, non-invasive bedside modality in visualizing Type A aortic dissections.
{"title":"Type A Aortic Dissection Presenting with Acute Lower Extremity Vascular Insufficiency in the Absence of Chest Pain","authors":"Thomas J. Earl, A. Poppas","doi":"10.4137/OJCS.S8042","DOIUrl":"https://doi.org/10.4137/OJCS.S8042","url":null,"abstract":"We report a case of a 53 year-old man with a history of hypertension presenting with acute left lower extremity parasthesias and pulselessness initially presumed to be secondary to arterial thrombosis or embolism. Work-up included a transthoracic echocardiogram which revealed an aortic dissection at the level of the aortic root extending to the visualized portions of the descending aorta. Type A aortic dissections are relatively rare, with the vast majority of patients presenting with chest pain. Timely diagnosis of Type A aortic dissections are critical as to facilitate rapid surgical repair. To our knowledge, this is the first report of a painless Type A aortic dissection presenting with isolated lower extremity vascular insufficiency and demonstrates the potential role of transthoracic echocardiography as a rapid, non-invasive bedside modality in visualizing Type A aortic dissections.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"5 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S8042","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Sabzi, A. Zokaei, Abdolrasoul Moloudi, S. Dabiri
Use of an intra-aortic balloon pump (IABP) is helpful for maintaining hemodynamic stability in patients with low cardiac output and compromised left ventricular function undergoing coronary artery bypass grafting. Although the incidence of complications has decreased significantly as experience with the device has increased, IABP use still carries a risk of complications. The most common complication is limb ischemia, mainly as a result of IABP entrapment and thromboembolism. Here we report a case of IABP entrapment in a nonatherosclerotic common iliac artery where forced removal caused fracture of the catheter.
{"title":"Intra-Aortic Balloon Pump Entrapment in a Nonatherosclerotic Common Iliac Artery","authors":"F. Sabzi, A. Zokaei, Abdolrasoul Moloudi, S. Dabiri","doi":"10.4137/OJCS.S7688","DOIUrl":"https://doi.org/10.4137/OJCS.S7688","url":null,"abstract":"Use of an intra-aortic balloon pump (IABP) is helpful for maintaining hemodynamic stability in patients with low cardiac output and compromised left ventricular function undergoing coronary artery bypass grafting. Although the incidence of complications has decreased significantly as experience with the device has increased, IABP use still carries a risk of complications. The most common complication is limb ischemia, mainly as a result of IABP entrapment and thromboembolism. Here we report a case of IABP entrapment in a nonatherosclerotic common iliac artery where forced removal caused fracture of the catheter.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"4 1","pages":"5 - 7"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S7688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taysir Garadah, Saleh Gabani, M. A. Alawi, Ahmed A. Abu-Taleb
Background The prevalence and epidemiological data of atrial fibrillation (AF) among multi-ethnic populations is less well studied worldwide. Aim Evaluation of the prevalence and predisposing factors of AF in patients who were admitted to acute medical emergencies (ER) in Bahrain over the period of one year. Methods Two hundred and fifty three patients with onset of AF were studied. The mean difference of biochemical data and clinical characteristics between Middle Eastern (ME) and sub continental (SC) patients was evaluated. The odds ratio of different predisposing factors for the development of clinical events in AF patients was assessed using multiple logistic regression analysis. Results Out of 7,450 patients that were admitted to ER over one year, 253 had AF based on twelve leads Electrocardiogram (ECG), with prevalence of 3.4%. In the whole study, the mean age was 59.45 ± 18.27 years, with 164 (65%) male. There were 150 ME patients (59%), and 107 (41%) SC, 55 (22%) were Indian (IND) and 48 (19%) were South Asian (SA). In the whole study clinical presentation was of 48% for palpitation, pulmonary edema was of 14%, angina pectoris on rest of 12%, 10% had embolic phenomena, 6% had dizziness, and 7% were asymptomatic. The odds ratio of different variables for occurrence of clinical events in the study was positive of 2.2 for history of hypertension, 1.8 for sickle cell disease, 1.2 for high body mass index (BMI) >30, 1.1 for mitral valve disease. The ME patients, compared with SC, were older, had significantly higher body mass index, higher history of rheumatic valve disease, sickle cell disease with high level of uric acid and lower hemoglobin. The history of hypertension, DM and smoking was higher among the SC patients. The rate of thyroid disease was equal in both groups. Conclusion The prevalence of atrial fibrillation was 3.4% with male predominance of 65%. Patients of sub continental origin were younger with a significantly high history of hypertension and ischemic heart disease. The patients of Middle Eastern origin had significantly high rate of rheumatic heart disease, and sickle cell disease. The history of hypertension was the most important independent clinical predictor of adverse events in patients presented with AF.
{"title":"Prevalence and Predisposing Factors of Atrial Fibrillation in a Multi-Ethnic Society: The Impact of Racial Differences in Bahrain","authors":"Taysir Garadah, Saleh Gabani, M. A. Alawi, Ahmed A. Abu-Taleb","doi":"10.4137/OJCS.S8032","DOIUrl":"https://doi.org/10.4137/OJCS.S8032","url":null,"abstract":"Background The prevalence and epidemiological data of atrial fibrillation (AF) among multi-ethnic populations is less well studied worldwide. Aim Evaluation of the prevalence and predisposing factors of AF in patients who were admitted to acute medical emergencies (ER) in Bahrain over the period of one year. Methods Two hundred and fifty three patients with onset of AF were studied. The mean difference of biochemical data and clinical characteristics between Middle Eastern (ME) and sub continental (SC) patients was evaluated. The odds ratio of different predisposing factors for the development of clinical events in AF patients was assessed using multiple logistic regression analysis. Results Out of 7,450 patients that were admitted to ER over one year, 253 had AF based on twelve leads Electrocardiogram (ECG), with prevalence of 3.4%. In the whole study, the mean age was 59.45 ± 18.27 years, with 164 (65%) male. There were 150 ME patients (59%), and 107 (41%) SC, 55 (22%) were Indian (IND) and 48 (19%) were South Asian (SA). In the whole study clinical presentation was of 48% for palpitation, pulmonary edema was of 14%, angina pectoris on rest of 12%, 10% had embolic phenomena, 6% had dizziness, and 7% were asymptomatic. The odds ratio of different variables for occurrence of clinical events in the study was positive of 2.2 for history of hypertension, 1.8 for sickle cell disease, 1.2 for high body mass index (BMI) >30, 1.1 for mitral valve disease. The ME patients, compared with SC, were older, had significantly higher body mass index, higher history of rheumatic valve disease, sickle cell disease with high level of uric acid and lower hemoglobin. The history of hypertension, DM and smoking was higher among the SC patients. The rate of thyroid disease was equal in both groups. Conclusion The prevalence of atrial fibrillation was 3.4% with male predominance of 65%. Patients of sub continental origin were younger with a significantly high history of hypertension and ischemic heart disease. The patients of Middle Eastern origin had significantly high rate of rheumatic heart disease, and sickle cell disease. The history of hypertension was the most important independent clinical predictor of adverse events in patients presented with AF.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"4 1","pages":"9 - 16"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S8032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taysir Garadah, S. Kassab, Saleh Gabani, Ahmed A. Abu-Taleb, Ahmed Abdelatif, A. Asef, Issa Shoroqi, A. Jamsheer
Background Hypertensive crisis (HC) is a common medical emergency associated with acute rise in arterial blood pressure that leads to end-organ damage (EOD). Therefore, it is imperative to find markers that may help in the prediction of EOD in acute hypertensive crisis. Aim To assess the clinical presentations on admission; echocardiographic changes of pulsed and tissue Doppler changes in EOD patients compared with no EOD; and the risk of developing end organ damage for clinical and biochemical variables in hypertension crisis. Material and Methods The data of 241 patients with hypertensive crisis with systolic blood pressure (SBP) of >180 mmHg or diastolic blood pressure (DBP) >120 mmHg were extracted from patients files. Patients divided into hypertensive emergency (HE) with EOD, n = 62 and hypertensive urgency (HU) without EOD, n = 179. LV hypertrophy on ECG, echo parameters for wall thickness, left Ventricular mass index (LVMI), Body mass index (BMI), pulse Doppler ratio of early filling velocity E wave to late A wave (E/A) and ratio of E wave velocity to tissue Doppler Em to E wave (E/Em) were evaluated. Serum creatinine, hemoglobin, age, gender, body mass Index (BMI), history of diabetes mellitus, smoking, hypertension, stroke and hyperlipidemia were recorded. Multiple logistic regression analysis was applied for risk prediction of end organ damage of clinical variables. Results Patients with HE compared with HU were significantly older, with a significantly higher SBP on admission, high BMI and LVMI. Further there were significantly higher E/A ratio on Doppler echo and higher E/Em ratio on tissue Doppler echocardiogram. Multiple regression analysis with adjustment for age and sex shows positive predictive value with odds ratio of SBP on admission >220 mmHg of 1.98, serum creatinine > 120 µg/L of 1.43, older age > 60 year of 1.304, obesity (BMI ≥ 30) of 1.9, male gender of 2.26 and left ventricle hypertrophy on ECG of 1.92. The hemoglobin level, history of smoking, hyperlipidemia and DM were with no significant predictive value. The pulsed Doppler E/A ratio was ≥1.6, E/Em > 15, LVMI > 125 gm/m2 in patients with EOD compared with those without. Conclusion In patients presented with hypertensive crisis, the echo indices of E/A ratio and E/Em ratio of tissue Doppler are significantly higher in patients with hypertensive emergency compared to hypertensive urgency. The left ventricle hypertrophy on ECG, high LV mass index of >125 gm/m2, BMI > 30, old age > 60 year, male gender and history of hypertension and stroke were positive predictors of poor outcome and end organ damage.
{"title":"Pulsed and Tissue Doppler Echocardiographic Changes in Hypertensive Crisis with and without End Organ Damage","authors":"Taysir Garadah, S. Kassab, Saleh Gabani, Ahmed A. Abu-Taleb, Ahmed Abdelatif, A. Asef, Issa Shoroqi, A. Jamsheer","doi":"10.4137/OJCS.S8094","DOIUrl":"https://doi.org/10.4137/OJCS.S8094","url":null,"abstract":"Background Hypertensive crisis (HC) is a common medical emergency associated with acute rise in arterial blood pressure that leads to end-organ damage (EOD). Therefore, it is imperative to find markers that may help in the prediction of EOD in acute hypertensive crisis. Aim To assess the clinical presentations on admission; echocardiographic changes of pulsed and tissue Doppler changes in EOD patients compared with no EOD; and the risk of developing end organ damage for clinical and biochemical variables in hypertension crisis. Material and Methods The data of 241 patients with hypertensive crisis with systolic blood pressure (SBP) of >180 mmHg or diastolic blood pressure (DBP) >120 mmHg were extracted from patients files. Patients divided into hypertensive emergency (HE) with EOD, n = 62 and hypertensive urgency (HU) without EOD, n = 179. LV hypertrophy on ECG, echo parameters for wall thickness, left Ventricular mass index (LVMI), Body mass index (BMI), pulse Doppler ratio of early filling velocity E wave to late A wave (E/A) and ratio of E wave velocity to tissue Doppler Em to E wave (E/Em) were evaluated. Serum creatinine, hemoglobin, age, gender, body mass Index (BMI), history of diabetes mellitus, smoking, hypertension, stroke and hyperlipidemia were recorded. Multiple logistic regression analysis was applied for risk prediction of end organ damage of clinical variables. Results Patients with HE compared with HU were significantly older, with a significantly higher SBP on admission, high BMI and LVMI. Further there were significantly higher E/A ratio on Doppler echo and higher E/Em ratio on tissue Doppler echocardiogram. Multiple regression analysis with adjustment for age and sex shows positive predictive value with odds ratio of SBP on admission >220 mmHg of 1.98, serum creatinine > 120 µg/L of 1.43, older age > 60 year of 1.304, obesity (BMI ≥ 30) of 1.9, male gender of 2.26 and left ventricle hypertrophy on ECG of 1.92. The hemoglobin level, history of smoking, hyperlipidemia and DM were with no significant predictive value. The pulsed Doppler E/A ratio was ≥1.6, E/Em > 15, LVMI > 125 gm/m2 in patients with EOD compared with those without. Conclusion In patients presented with hypertensive crisis, the echo indices of E/A ratio and E/Em ratio of tissue Doppler are significantly higher in patients with hypertensive emergency compared to hypertensive urgency. The left ventricle hypertrophy on ECG, high LV mass index of >125 gm/m2, BMI > 30, old age > 60 year, male gender and history of hypertension and stroke were positive predictors of poor outcome and end organ damage.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"4 1","pages":"17 - 24"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S8094","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives Myocardial hypertrophy represents a great challenge in cardiac surgery. Several strategies have been described to protect the hypertrophied myocardium during cardiopulmonary bypass, and aortic clamping, yet the ideal strategy has not been identified. This study investigates the use of moderate systemic hypothermia (MSH) as an adjuvant method to protect the hypertrophied myocardium in patients undergoing aortic valve replacement (AVR). Methods Twenty eight patients undergoing AVR were divided into two groups, (Group I) received continuous cold 5–8 °C retrograde blood cardioplegia (CRBC) and their body temperature was cooled down to 23–26 °C. (Group II) also received CRBC but their body temperature was kept at 32–34 °C. Results No operative morality (30 days) was noted in both groups. Postoperative reduction in ejection fraction (EF) was seen in nine patients of group I and in twelve patients of group II (P < 0.05). The need for multiple inotropes was more in group II (eight patients) than in group I (two patients) (P < 0.001). IABP was needed in three patients of group II and non in group I (P < 0.01). Conclusion Moderate systemic hypothermia might have a role in protecting hypertrophied myocardium in patients undergoing AVR.
{"title":"Operative Myocardial Protection in Patients with Left Ventricular Hypertrophy: The Role of Systemic Hypothermia","authors":"Tamer Elghobary, I. Ali, A. F. Ahmad","doi":"10.4137/OJCS.S6937","DOIUrl":"https://doi.org/10.4137/OJCS.S6937","url":null,"abstract":"Objectives Myocardial hypertrophy represents a great challenge in cardiac surgery. Several strategies have been described to protect the hypertrophied myocardium during cardiopulmonary bypass, and aortic clamping, yet the ideal strategy has not been identified. This study investigates the use of moderate systemic hypothermia (MSH) as an adjuvant method to protect the hypertrophied myocardium in patients undergoing aortic valve replacement (AVR). Methods Twenty eight patients undergoing AVR were divided into two groups, (Group I) received continuous cold 5–8 °C retrograde blood cardioplegia (CRBC) and their body temperature was cooled down to 23–26 °C. (Group II) also received CRBC but their body temperature was kept at 32–34 °C. Results No operative morality (30 days) was noted in both groups. Postoperative reduction in ejection fraction (EF) was seen in nine patients of group I and in twelve patients of group II (P < 0.05). The need for multiple inotropes was more in group II (eight patients) than in group I (two patients) (P < 0.001). IABP was needed in three patients of group II and non in group I (P < 0.01). Conclusion Moderate systemic hypothermia might have a role in protecting hypertrophied myocardium in patients undergoing AVR.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"4 1","pages":"1 - 4"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S6937","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The presence of a patent internal mammary artery (IMA) represents a well-known technical challenge in redo cardiac surgery. Dissection of the IMA and controlling its flow during cardioplegic delivery has thus been considered essential steps. This maneuver however, is associated with the risk of damaging the IMA. Herein, we report a technique, which involves no attempts to dissect, or clamp the IMA in 44 consecutive redo cardiac surgery procedures. The results demonstrate that this technique is simple, safe, and reduces the chance of IMA injury.
{"title":"Simple Techniques to Manage the Patent Internal Mammary Artery in Redo Cardiac Surgery","authors":"Ahmed Ahmed, I. Ali, I. Ali, Jacob Cookey","doi":"10.4137/OJCS.S4507","DOIUrl":"https://doi.org/10.4137/OJCS.S4507","url":null,"abstract":"The presence of a patent internal mammary artery (IMA) represents a well-known technical challenge in redo cardiac surgery. Dissection of the IMA and controlling its flow during cardioplegic delivery has thus been considered essential steps. This maneuver however, is associated with the risk of damaging the IMA. Herein, we report a technique, which involves no attempts to dissect, or clamp the IMA in 44 consecutive redo cardiac surgery procedures. The results demonstrate that this technique is simple, safe, and reduces the chance of IMA injury.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S4507","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. I. Macedo, Enisa M. Carvalho, E. Gologorsky, M. Barron, Mohammed F Hassan, T. Salerno
Lung perfusion/ventilation was introduced as a means to minimize cardiopulmonary (CPB)-related pulmonary ischemic injury. Current results in the literature are divergent, and the role of gas exchange during lung perfusion/ventilation during CPB, remains undefined. This report details a) the technique of continuous lung perfusion/ventilation during CPB, b) provides initial observations, and c) discusses gas exchange during CPB.
{"title":"Gas Exchange during Lung Perfusion/Ventilation during Cardiopulmonary Bypass: Preliminary Results of a Pilot Study","authors":"F. I. Macedo, Enisa M. Carvalho, E. Gologorsky, M. Barron, Mohammed F Hassan, T. Salerno","doi":"10.4137/OJCS.S4109","DOIUrl":"https://doi.org/10.4137/OJCS.S4109","url":null,"abstract":"Lung perfusion/ventilation was introduced as a means to minimize cardiopulmonary (CPB)-related pulmonary ischemic injury. Current results in the literature are divergent, and the role of gas exchange during lung perfusion/ventilation during CPB, remains undefined. This report details a) the technique of continuous lung perfusion/ventilation during CPB, b) provides initial observations, and c) discusses gas exchange during CPB.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S4109","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2010-01-01DOI: 10.4137/117906521000300001
O. Tiryakioglu, H. Ari, S. Tiryakioğlu, A. Ozyazicioglu
An iatrogenic systemic venous return abnormality was found in a female patient who had previously undergone surgery to correct a superiorly located atrial septal defect and then had increasing complaints. Here we consider the importance of contrast echocardiography in the diagnosis and discuss the patient's second operation as well as the possible mistakes in the first operation.
{"title":"Iatrogenic Systemic Venous Return Abnormality","authors":"O. Tiryakioglu, H. Ari, S. Tiryakioğlu, A. Ozyazicioglu","doi":"10.4137/117906521000300001","DOIUrl":"https://doi.org/10.4137/117906521000300001","url":null,"abstract":"An iatrogenic systemic venous return abnormality was found in a female patient who had previously undergone surgery to correct a superiorly located atrial septal defect and then had increasing complaints. Here we consider the importance of contrast echocardiography in the diagnosis and discuss the patient's second operation as well as the possible mistakes in the first operation.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/117906521000300001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70678039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Linneweber, P. Swojanowsky, P. Dohmen, H. Grubitzsch, S. Dushe, S. Holinski, W. Konertz
Objective Aim of the study was to analyze changes over a ten years observation period regarding demography, indication for support and clinical outcome in patients treated with short-term mechanical circulatory support (MCS) for cardiogenic failure. Methods 39 patients treated with MCS between 2006–2008 (2008 group) were analyzed, assessing demography, complication rates and survival. Results were compared with 36 consecutive patients that had received centrifugal MCS between 1996–1998 (1998 group) at our institution. Results Mean age was 59.9 ± 12.9 (1998 group) and 60.9 ± 13.9 years (P = 0.74). Mean logEuroScores rose from 12.0% ± 14.6% (1998 group) to 26.9% ± 20.5% (2008 group); P < 0.001. Postcardiotomy low output syndrome was the main cause for MCS. However the percentage of patients in cardiogenic shock prior to surgery increased from 19.4% (1998 group) to 33.3% (2008 group); P = 0.17. Complexity and urgency of the primary surgical procedure increased significantly. 16.7% (1998 group) vs. 41.0% (2008 group); P = 0.02 of interventions were classified “salvage/emergent”. Mean duration of support was 2.9 ± 1.9 days (1998 group) and 3.8 ± 3.1 days (2008 group); P = 0.14. Significantly more biventricular support was implemented in the 2008 group (23.1% vs. 5.6% in the 1998 group); P = 0.03. The incidence of complications, including device failure, thromboembolism and infection remained the same in both groups. 63.9% (1998 group) and 61.5% (2008 group) of the patients were successfully weaned from the device (P = 0.83), 12% (1998 group) and 3% (2008 group) of the VAD patients were bridged to long-term VAD (P = 0.12). Overall 30-day survival rates were similar (22.2% 1998 group vs. 28.2%; 2008 group); P = 0.55, however, survival rate in BVAD supported patients improved significantly. Conclusion These data demonstrate the beneficial effect of MCS to salvage patients with cardiac failure. Taking into consideration that the severity of illness, the complexity and urgency of the primary surgical procedure have steadily increased a comparable improvement in MCS outcome over the past decade was observed. Nevertheless, in-hospital mortality and VAD related complication rates such as bleeding remain high.
{"title":"Single Center Experience with Short-term Circulatory Support: A Comparison of Demography, Indication and Clinical Outcome over the past Decade","authors":"J. Linneweber, P. Swojanowsky, P. Dohmen, H. Grubitzsch, S. Dushe, S. Holinski, W. Konertz","doi":"10.4137/OJCS.S5396","DOIUrl":"https://doi.org/10.4137/OJCS.S5396","url":null,"abstract":"Objective Aim of the study was to analyze changes over a ten years observation period regarding demography, indication for support and clinical outcome in patients treated with short-term mechanical circulatory support (MCS) for cardiogenic failure. Methods 39 patients treated with MCS between 2006–2008 (2008 group) were analyzed, assessing demography, complication rates and survival. Results were compared with 36 consecutive patients that had received centrifugal MCS between 1996–1998 (1998 group) at our institution. Results Mean age was 59.9 ± 12.9 (1998 group) and 60.9 ± 13.9 years (P = 0.74). Mean logEuroScores rose from 12.0% ± 14.6% (1998 group) to 26.9% ± 20.5% (2008 group); P < 0.001. Postcardiotomy low output syndrome was the main cause for MCS. However the percentage of patients in cardiogenic shock prior to surgery increased from 19.4% (1998 group) to 33.3% (2008 group); P = 0.17. Complexity and urgency of the primary surgical procedure increased significantly. 16.7% (1998 group) vs. 41.0% (2008 group); P = 0.02 of interventions were classified “salvage/emergent”. Mean duration of support was 2.9 ± 1.9 days (1998 group) and 3.8 ± 3.1 days (2008 group); P = 0.14. Significantly more biventricular support was implemented in the 2008 group (23.1% vs. 5.6% in the 1998 group); P = 0.03. The incidence of complications, including device failure, thromboembolism and infection remained the same in both groups. 63.9% (1998 group) and 61.5% (2008 group) of the patients were successfully weaned from the device (P = 0.83), 12% (1998 group) and 3% (2008 group) of the VAD patients were bridged to long-term VAD (P = 0.12). Overall 30-day survival rates were similar (22.2% 1998 group vs. 28.2%; 2008 group); P = 0.55, however, survival rate in BVAD supported patients improved significantly. Conclusion These data demonstrate the beneficial effect of MCS to salvage patients with cardiac failure. Taking into consideration that the severity of illness, the complexity and urgency of the primary surgical procedure have steadily increased a comparable improvement in MCS outcome over the past decade was observed. Nevertheless, in-hospital mortality and VAD related complication rates such as bleeding remain high.","PeriodicalId":90668,"journal":{"name":"Open journal of cardiovascular surgery","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2010-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.4137/OJCS.S5396","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70713129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
O. Tiryakioglu, S. Tiryakioğlu, H. Ari, H. Vural, A. Ozyazicioglu
We experienced a successful surgical Williams's syndrome case of extended aortoplasty by means of Doty's method (two sinus reconstructions) for congenital supravalvular aortic stenosis. Case was 29-year-old woman, who had no complaint except heart murmur and dyspnea. The retrograde aortography and Digital Subtraction Angiography (DSA) demonstrated localized stenosis just above the aortic valve, and it was an hour-glass type. This case showed excellent results. Doty's aortoplasty was favorable method for supravalvular aortic stenosis without deformity of aortic valve and coronary obstruction.
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