Predictors of early graft patency following coronary artery bypass surgery

Background: The long-term success of coronary artery bypass graft surgery (CABG) is dependent on graft patency after the operation. Early occlusion (within the first week) affects the long-term results. Therefore, we sought to determine pre-operative, intraoperative, and perioperative factors associated with early coronary graft patency. Methods: Between March 2007 and March 2008, 107 consecutive patients (81 men, 26 women, mean age 60 &#177; 9 years) who underwent CABG were included in this study. The enrolled patients underwent 16-slice computed tomography angiography one week after CABG. Results: Based on the multislice computed tomography, acute graft occlusion was detected in 32 (8.7% of all) grafts, including 26 of 250 (10%) in venous grafts and 6 of 116 (5%) in arterial grafts. In univariate analysis, patients with patent coronary grafts had a lower serum glucose level (119 &#177; 30 vs. 141 &#177; 65 mg/dL, p = 0.02) and longer partial thromboplastin time (34 &#177; 11 vs. 30 &#177; 2 s, p = = 0.04). In addition, pump time was significantly longer in patients with occluded grafts than in those with patent grafts (119 &#177; 43 vs. 102 &#177; 32 min, p = 0.04). Those with longer pump time required more coronary grafts (pump time &#8805; 120 min for 3.5 grafts vs. pump time < 120 min for 2.9 grafts, p = 0.02). Of the multiple pre-operative, intraoperative, and perioperative characteristics of the patients who underwent successful CABG, serum glucose level (OR: 2.014, 95% CI: 1.002-3.026, p = 0.002) and pump time < two hours (OR: 1.502, 95% CI: 1.001-2.030, p = 0.003) were the only predictors of coronary graft patency seven days after surgery in multivariate analysis. Conclusions: Our study demonstrated that the patients with successful CABG and patent coronary grafts within the first week after surgery had optimal blood glucose control and pump time < two hours. (Cardiol J 2010; 17, 4: 344-348

Goal-directed therapy in cardiovascular surgery: A case series study

Hemodynamic and intravascular volume monitoring has been utilized and significantly improved thanks to the technology revolution. Goal-Directed Therapy (GDT) derived from this advanced monitoring is beneficial for complex surgeries, and it shifted the medical approaches from static therapy to more personalized functional treatments. Conventional monitoring methods such as blood pressure, heart rate, urinary output, and central venous pressure are commonly used. However, studies have shown these routine parameters often cannot precisely estimate the quality of tissue perfusion. Tissue hypoperfusion and hypoxia play a crucial role in initiating a systemic inflammatory response after prolonged surgeries, resulting in unstable hemodynamic condition of the patients. Several studies reported the importance of GDT in non-cardiac surgeries and there are few reports on cardiac surgeries. However, tissue perfusion and fluid management are more critical in complex and prolonged cardiovascular surgeries to avoid complications such as low cardiac output syndrome and renal or pulmonary dysfunction. Different advanced hemodynamic monitorings have been utilized perioperatively in cardiac surgery to help decision-making on inotrope and fluid management. In this article we present 5 cases of usefulness hemodynamic monitoring in patients who underwent cardiovascular surgeries

Czynniki wpływające na wczesną drożność pomostów naczyniowych u pacjentów poddawanych pomostowaniu aortalno-wieńcowemu

Wstęp: Sukces terapeutyczny pomostowania aortalno-wieńcowego (CABG) w odległej obserwacji zależy od drożności pomostów naczyniowych po zabiegu. Wczesne zamknięcie pomostu (w ciągu pierwszego tygodnia po CABG) wpływa niekorzystnie na odległe wyniki leczenia. Celem niniejszego badania było określenie czynników przed-, śród- i pooperacyjnych, które mogą się wiązać z drożnością pomostów aortalno-wieńcowych we wczesnym okresie po CABG. Metody: Badanie prowadzono od marca 2007 do marca 2008 roku. Do udziału w nim zakwalifikowano 107 kolejno przyjętych pacjentów (81 mężczyzn, 26 kobiet; średnia wieku: 60 &#177; 9 lat), których poddano CABG. Tydzień po zabiegu u chorych wykonano angiografię tomografii komputerowej (TK) przy użyciu 16-rzędowej TK. Wyniki: Na podstawie obrazowania wielorzędowej TK w 32 pomostach naczyniowych (8,7% wszystkich wszczepionych naczyń) stwierdzono ostrą okluzję, z czego 26 okluzji spośród 250 wykonanych zespoleń (10%) wystąpiło w pomostach żylnych, a 6 z 116 (5%) &#8212; w tętniczych. W wieloczynnikowej analizie u pacjentów z drożnymi pomostami aortalno-wieńcowymi odnotowano niższe stężenie glukozy w osoczu (119 &#177; 30 ml/dl v. 141 &#177; 65 ml/dl; p = 0,02) i dłuższy czas częściowej tromboplastyny po aktywacji (34 &#177; 11 s v. 30 &#177; 2 s; p = 0,04). Ponadto czas wykorzystania krążenia pozaustrojowego był znacznie dłuższy u osób z zamkniętymi pomostami niż u tych z drożnymi wszczepionymi naczyniami (119 &#177; 43 min v. 102 &#177; 32 min; p = 0,04). U chorych z dłuższym czasem krążenia pozaustrojowego konieczne było zastosowanie większej liczby pomostów aortalno-wieńcowych (czas &#8805; 120 min dla 3,5 pomostu v. czas < 120 min dla 2,9 pomostu; p = 0,02). Spośród licznych parametrów przed-, śród- i pooperacyjnych jedynie stężenie glukozy w osoczu [iloraz szans (OR): 2,014; przy 95-procentowym przedziale ufności (95% CI): 1,002&#8211;3,026; p = 0,002] i czas krążenia pozaustrojowego poniżej 2 godzin (OR: 1,502; 95% CI: 1,001&#8211;2,030; p = 0,003) były czynnikami predykcyjnymi drożności pomostów aortalno-wieńcowych po upływie 7 dni od CABG. Wnioski: U pacjentów po operacji CABG zakończonej sukcesem, z drożnymi pomostami naczyniowymi w ciągu pierwszego tygodnia po operacji stężenie glukozy w osoczu było optymalnie kontrolowane, a czas operacji z wykorzystaniem krążenia pozaustrojowego nie przekraczał 2 godzin. (Folia Cardiologica Excerpta 2010; 5, 6: 325&#8211;330

Midterm Results After Surgical Correction of Total Anomalous Pulmonary Venous Connection

Objective:To evaluate the surgical treatment of total anomalous pulmonary venous connection (TAPVC) and determination of predictors for postoperative death.Methods:Between 1995 and 2005,80 patients aged from 1 month to 12 years underwent surgical repair for supracardiac (39),cardiac (34),infracardiac (3)or mixed(4) type of TAPVC.Systemic pulmonary hypertension PH) in 53.8% of patients, half systemic PH in 26.3% and mild pH (<40 mmHg) were found by preoperative evaluations. Twelve patients (15%) had some degree of pulmonary vein obstruction preoperatively. Results: Seven patients (8.7%) died in the operating room. Early postoperative mortality (during 48 hours) occurred in 11 cases (13.7%) and nine patients died during first hospitalization. We did not have late mortality in survivors during follow-up period; therefore the overall mortality rate was 33.8%. The incidence of postoperative death was highest in the infracardiac type (2/3). Approximately two-thirds of dead patients (21/27) had presented with systemic PH and 89% of them had at least half-systemic PH preoperatively. Mortality rate in patients with normal pulmonary artery pressure (PAP) was zero. Conclusion: In contrast to early surgical results we had excellent mid-term outcome. The role of myocardial protection and surgical technique are the most probable causes of high death rate in our series. However influences of poor preoperative stabilization process as well as anesthetic technique and cardiopulmonary bypass related problems should be considered. PAP more than half of systemic pressure and patient age smaller than 3 months were the primary predictive factors for premature death (P<0.05)

Intraluminal Ascending Aorta Fibroma

Primary cardiac tumors are quite rare, especially in the pediatric age group, and their atypical presentations often prevent a timely diagnosis. Most primary cardiac tumors in the pediatric age group are benign. Fibromas are generally reported as the second most common primary cardiac tumors in the pediatric age group. These neoplasms are often intramural and involve the left ventricular free wall or the interventricular septum. Although benign, fibromas may become life-threatening by causing arrhythmias or obstruction to the blood flow. A case of supravalvular intraluminal ascending aorta fibroma in a 23-month-old girl, presenting with syncope, is described here; the location is rare and the presentation atypical for this type of tumor. Transesophageal echocardiography helped us to evaluate the anatomic details of the tumor and plan surgery

Supravalvar Mitral Ring: a Case Report

Supravalvar mitral ring is a rare congenital heart defect of surgical importance. The condition is characterized by an abnormal ridge of the connective tissue on the atrial side of the mitral valve. It often substantially obstructs the mitral valve inflow. We herein introduce a case of a supravalvar mitral ring in a 17-year-old male, who was admitted to our hospital with cardiac syncope. He had undergone a cardiac operation for ventricular septal defect (VSD) closure and mitral valve repair 15 years before. Transthoracic echocardiography, transesophageal echocardiography, and finally cardiac catheterization revealed a neglected supravalvular mitral ring. The ring was resected in a second operation, and the patient was discharged from the hospital symptom free

Recurrence rate of different techniques for repair of coarctation of aorta: A 10 years experience

Background and Aim : The main goal of this study was to assess the frequency of recurrent coarctation after repair using different surgical methods. Methods : Surgical results of repairs for coarctation of aorta (Co-A) in 188 patients under the age 14 years who were treated in Rajaee Heart Center, Tehran, Iran, were evaluated retrospectively. The most common methods included patch-graft aortoplasty (59), resection with end-to-end anastomosis (20.7) and subclavian flap aortoplasty (SCFA) (16.5). The remaining patients underwent bypass tube graft and excision with placement of a tube graft. Seventy eight percent had discrete stenosis while 22 had long segment narrowing. The patients were followed for 81.632.8 months. Results : The overall mortality rate was 2.6. The highest incidence rate of recoarctation was found in the patch-graft aortoplasty group (12.7) and the lowest was found in SCFA (3.2). The incidence of recoarctation in long-segment lesions was significantly higher than that in the discrete ones (30 vs. 4, P<0.001). In patients <1 year, the incidence of recoarctation was lower than that in the other age groups. Conclusion : The patch-graft aortoplasty technique had the highest incidence of recoarctation and SCFA had the lowest rate. Long-segment Co-A had a higher chance of recoarctation. In contrast to some previous reports, the incidence of recoarctation was not higher in the age below 1 year

Modified Blalock-Taussig Shunt and Giant Perigraft Reaction

This is a case of a modified Blalock-Taussig shunt, which was complicated by perigraft transudative, fibrinous fluid accumulation and recurrence after surgical intervention. Follow-up and expectant management of the patient was successful. Our experience regarding this complication is presented

Anesthetic management in a patient with type A aortic dissection and superior vena cava syndrome

Introduction: Induction of general anesthesia in patients with superior vena cava (SVC) syndrome may cause airway obstruction and cardiovascular collapse. Case Presentation: Herein, we introduced a patient with the diagnosis of dissecting aneurysm of the ascending aorta who was candidate for emergency surgery. He also had symptoms of SVC syndrome. To maintain airway patency during anesthetic management, we decided to perform femoro-femoral cardiopulmonary bypass followed by general anesthesia and tracheal intubation. Conclusions: Femoro-femoral bypass prior to initiation of sternotomy is a safe and easy method in patients with aortic dissection and SVC syndrome in whom earlier endotracheal intubation may not be feasible