Role of Short-Term Percutaneous Mechanical Circulatory Support Devices as Bridge-to-Heart Transplantation

Cardiogenic shock is a life-threatening condition and mortality remains high if there is no response with medical therapy. Recently, short-term percutaneous mechanical circulatory support (pMCS) devices have increased in use for refractory cardiogenic shock. These devices can provide full treatment or bridging to long-term MCS devices if patients need long-term support. There are four types of well-known MCS devices including Impella (Abiomed, Danvers, MA), TandemHeart (CardiacAssist, Pittsburgh, PA), and extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pump for short-term and percutaneous application. In this chapter, we aim to discuss the physiologic concept, clinical evidences and applications, indications-contraindications, complications, and comparison of these most commonly used short-term pMCS devices for advanced heart failure

Role of Cholesterol as a Risk Factor in Cardiovascular Diseases

Cardiovascular disease is the most common cause of death in adult population in the world. The disease includes numerous problems, many of which are related to a process called atherosclerosis. Atherosclerosis is a condition that develops when a substance called plaque builds up in the walls of the arteries. This plaque narrows the arteries, making it harder for blood to flow through. If a blood clot forms, it can stop the blood flow. This can cause a heart attack or stroke. There are many risk factors associated with cardio vascular disease (CVD). While some risk factors cannot be changed, such as family history, some of them can be modified with treatment such as abnormal blood lipid and sugar levels, obesity, smoking, and high blood pressure. Research makes it clear that abnormal blood lipid (fat) levels have a strong correlation with the risk of coronary artery disease, heart attack and coronary death. Cholesterol plays detrimental roles in the pathogenesis of atherosclerosis and CVD. In this chapter, we aim to summarize the relationship between blood cholesterol levels and CVD

Staged approach for surgical management of a true femoral artery aneurysm combined with bilateral iliac artery aneurysms

True femoral artery aneurysm is a rare vascular entity and is often associated with aortic or peripheral aneurysms. Life-threatening complications associated with peripheral arterial aneurysms include rupture, thrombosis, and embolization. In patients with multiple aneurysms, any symptomatic aneurysms should be treated first; in asymptomatic patients, the aneurysms can be repaired either simultaneously in a single operation or serially in a staged procedure. We report a case of concomitant true femoral aneurysm and bilateral iliac artery aneurysms, which were treated with a combination of open surgical and endovascular techniques

The predictive value of the prognostic nutritional index for postoperative acute kidney injury in patients undergoing on-pump coronary bypass surgery

Abstract Background We aimed to investigate the predictive value of the prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after elective coronary artery bypass grafting (CABG). Methods A total of 336 consecutive patients with normal serum creatinine levels undergoing CABG were enrolled in this retrospective study. AKI was defined as meeting Acute Kidney Injury Network (AKIN) criteria based on the occurrence of creatinine changes within the first 48 h after CABG surgery. The patients were grouped according to whether they developed AKI or not into an AKI (−) and an AKI (+) group. Results AKI developed in 88 (26.2%) of all patients. The PNI was independently predictive of AKI (OR: 0.829, 95% CI: 0.783–0.877, p <  0.001). Moreover, C-reactive protein (CRP), a history of diabetes mellitus, and positive inotropric usage were independent risk factors for AKI in the multivariate logistic regression analysis. The area under the curve (AUC) of the multivariable model, including positive inotrope support, a history of diabetes mellitus, and CRP, was 0.693 (95% CI: 0.626–0.760, p <  0.001) in predicting AKIN. When the PNI was added to the multivariable model, the AUC was 0.819 (95% CI, 0.762–0.865, z = 3.777, difference p = 0.0002). Also, the addition of the PNI to the multivariable model was associated with a significant net reclassification improvement estimated at 88.2% (p <  0.001) and an integrated discrimination improvement of 0.22 (p <  0.001). Conclusions Our study demonstrated that decreasing the PNI could be associated with the development of AKI after coronary artery bypass surgery

Using Soluble ST2 to Predict Adverse Postoperative Outcomes in Patients with Impaired Left Ventricular Function Undergoing Coronary Bypass Surgery

Background and Objectives: The aim of this study was to investigate the prognostic value of soluble ST2 (sST2) in predicting postoperative adverse events in patients with impaired left ventricular (LV) function undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: This study included 80 consecutive patients with stable coronary artery disease (CAD) and impaired LV function (ejection fraction &le; 45%) undergoing on-pump coronary artery bypass graft surgery. The patients were divided into the &ldquo;high&rdquo; or &ldquo;low&rdquo; group according to their ST2 levels (&ge;35 or &lt;35 ng/mL). Results: Postoperative adverse events were more common in patients with high sST2 levels than in patients with low sST2 levels (100% vs 26%, p &lt; 0.0001). Multivariate analysis showed that sST2 level was an independent predictor of the presence of postoperative adverse events (OR: 1.117 (95% CI: 1.016&ndash;1.228), p = 0.022). The receiver operating characteristic curve (ROC) analysis of sST2 revealed an area under the curve (AUC) of 0.812 (95% CI: 0.710&ndash;0.913, p &lt; 0.001) in predicting postoperative adverse events. An sST2 level of 26.50 ng/ml was identified as the optimal cut-off value, with a sensitivity and specificity of 74.1% and 75.3%, respectively. Conclusion: Higher sST2 levels were associated with adverse outcomes after CABG in patients with impaired LV and stable CAD

Chylothorax After Thoracoabdominal Aneurysm Repair: Efficacy of Somatostatin

WOS: 000287189000030PubMed ID: 20926242Chylothorax is a rare but serious complication that presents after thoracoabdominal aortic aneurysm surgery. There are insufficient data to reach a consensus on how to manage it. Some researchers have suggested early reoperation for high output drainage. We present the case of a patient who underwent thoracoabdominal aortic replacement and who subsequently developed postoperative chylothorax. High output (> 1,000 mL per day) chest tube drainage until postoperative day 4 drastically decreased and stopped in a week with the administration of somatostatin and total parenteral nutrition which helped avoid a major re-exploration. Surgery should be reserved as an option only for patients with persistent leaks that do not respond to somatostatin therapy