Brain preservation with selective cerebral perfusion, moderate hypothermia and low flow rate

BackgroundHypothermic circulatory arrest (HCA) is employed for aortic arch and other complex operations, often with selective cerebral perfusion (SCP). Our previous work has demonstrated real-time evidence of improved brain protection using SCP at 18°C. The purpose of this study was to evaluate the utility of SCP at warmer temperatures (25°C) and its impact on operating times.MethodsFrom 2000 to 2010, 116 patients diagnosed IAA, 40 IAA with VSD, 31 single ventricle, 19 Coa with VSD, 17 DORV, 6 TGA and 3 CAVD underwent total repair using SCP 25–23 hypothermia with low flow rate for 20–35min. Circulatory arrest (CA), cross clamp (Cx), CPB and post-op complications are retrospectively analyzed.ResultsThe mean age 12–35days, weight 1.9–4.0. The complexity of the disease was determinant in the CPB and CX time, the lowest temperature was 19 in very selected patients, the average temp. was 23°C. CA was in 18 (6.4%). 27% delay sterna closure. Wound infection 11% and 8% mortality.ConclusionOur study supports the conclusion that systemic circulatory arrest with selective cerebral perfusion at 25°C can be safely performed while providing comparable cerebral and end-organ protection to that of 18°C with SCP. In addition, the employment of a more tepid temperature allows for significantly shorter operative times, which may clinically translate into improved outcomes for children undergoing surgical repair of complex congenital heart defects

Off-pump coronary revascularization: A potential benefit for female patients?

AbstractCoronary artery disease is one of the leading causes of illness for both men and women. However, women are 3 times more likely to die for coronary artery disease as they are of breast cancer. There are an increasing prevalence of coronary artery disease in women and thus facing the need for surgical revascularization. It has long being accepted that women carry a high risk of coronary surgery than men. Many investigators have suggested that female itself is predictive of poor outcome after on pump coronary surgery. We thought to search the litlature to investigate whether women who undergo off-pump surgery receive any benefits compared with women undergoing on-pump surgery

Optical Properties of (Polystyrene-Wood buckthorn Peel) Composites

In this work, samples of pure polystyrene and polystyrene (PS) doped with wood buckthorn peel (WBP)  were prepared using casting method .The effect of addition of wood buckthorn peel (WBP) concentration on optical properties of poly styrene have been studied in the wavelength range (200-800)nm. The absorption coefficient ,energy gap, refractive index and extinction coefficient have been determined. The results show that the optical constants change with increase of WBP concentration . Key words; polymer , PS, wood buckthorn peel (WBP)  , Optical properties, absorbance

Thermal Energy Storage by Nanofluids

Nanofluids are suspensions of nanoparticles in base fluids, a new challenge for thermal sciences provided by nanotechnology. Nanofluids have unique features different from conventional solid-liquid mixtures in which mm or ?m sized particles of metals and non-metals are dispersed. At  this research adding of small weight percent of magnesium oxide MgO(0.1, 0.2, 0.4 and 0.5wt.%) to pure water as working fluid in the building heating system by solar energy gave us different behavior, adding 0.1, 0.2wt,% gave low temperature gradient than the pure water, while 0.4 and 0.5wt.% gave greater temperature gradient than pure water which is desired. Keywords: Nanomaterials, Nanofluids, Thermal Energy, Energy Storage

Impact of chylothorax on the post operative outcome after pediatric cardiovascular surgery

BackgroundChylothorax is the accumulation of chyle in the pleural cavity, usually develops after disruption of the thoracic duct along its intra-thoracic route. In the majority of cases this rupture is secondary to trauma (including cardio thoracic surgeries). Chylothorax is a potentially serious complication after cardiovascular surgeries that require early diagnosis and adequate management.MethodsA retrospective study of all cases complicated with chylothorax after pediatric cardiac surgery in King Abdulaziz Cardiac Center between January 2007 and December 2009 was conducted. The study aim to determine the risk factors, and the impact on the post operative course.ResultsWe have 1135 cases operated during the study period, 57 cases (5%) were complicated with chylothorax in the post operative period. The most common surgeries complicated with chylothorax were the single ventricle repair surgeries (Glenn-Fontan) 15 cases (27%), followed by the arch repair cases 10 cases (18%), the ventricular septal defect cases 10 cases (18%), the Atrioventricular septal defect cases 7 cases (12%), the arterial switch cases 6 cases (11%), and others 8 cases (14%). The ICU stay, the length of hospital stay and the bypass time were significantly longer in the chylothorax group, also the ventilation time, the inotropes duration and number were higher in the chylothorax group.ConclusionChylothorax after pediatric open heart surgery is not an uncommon complication, it occurs more commonly with single ventricle repair and aortic arch repair surgeries, it has a significant impact on the post operative course and post operative morbidity

Gender differences in the surgical management and early clinical outcome of coronary artery disease: Single centre experience

AbstractObjectiveTo investigate the gender disparity in the distribution of patient-related risk factors and their effect on the surgical management and clinical outcome of coronary artery disease in Saudi population.Materials and methodsWe carried out a retrospective analysis of prospectively collected data of 971 patients undergoing isolated coronary artery bypass grafting (CABG) at our institution between January 2005 and December 2008. Seven hundred and eighty seven patients (81%) were males and 184 patients (19%) were females. We analyzed gender-based difference in clinical presentation and patient-related pre-operative risk factors and studied their impact on surgical management and clinical outcome.ResultsThe mean age was 59.5 years in males and 63.4 years in females (p=<0.0001). Associated co-morbidities were higher in females. Prevalence of diabetes mellitus was 61.2% in males and 78.8% in females (p-value=<0.0001); hypertension 61.9% in males and 79.9% in females (p-value <0.0001); hyperlipidemia 66.7% in males and 77.7% in females (p-value 0.0035); morbid obesity 24.7% in males and 45.1% in females (p-value <0.0001); and Hypothyroidism 2.5% in males and 13.6% in females (p-value <0.0001). Smoking was the only risk factor with higher prevalence in males compared to females (44.2% v/s 2.2%; p-value <0.0001). The mean logistic euroSCORE was 3.94 in males and 5.51 in females (p<0.0003). On-pump and off-pump CABG was carried out in equal numbers in two groups. Females required urgent surgery and less than 3 grafts more frequently while males underwent elective surgery and more than 3 grafts in greater numbers. No significant difference was present between the two gender groups in aortic occlusion times and bypass times. Univariant analysis revealed females gender as an independent risk factor for higher in-hospital mortality (1.1% versus 4.9% p=0.0026) and higher incidence of post-operative complications like surgical wound infection, need for prolonged ventilation, low cardiac output state and multi-organ failure (p-values 0.01 or less).ConclusionFemale gender is an independent predictor of adverse outcome after isolated CABG due to significantly higher co-morbidities and acute presentation and independent of their peri-operative management. Therefore, major socioeconomic education and preventive measures are needed to reduce the burden of major co-morbidities in females and to seek early cardiac advice and care

Human fitting of pediatric and infant continuous-flow total artificial heart: visual and virtual assessment

BackgroundThis study aimed to determine the fit of two small-sized (pediatric and infant) continuous-flow total artificial heart pumps (CFTAHs) in congenital heart surgery patients.MethodsThis study was approved by Cleveland Clinic Institutional Review Board. Pediatric cardiac surgery patients (n = 40) were evaluated for anatomical and virtual device fitting (3D-printed models of pediatric [P-CFTAH] and infant [I-CFTAH] models). The virtual sub-study consisted of analysis of preoperative thoracic radiographs and computed tomography (n = 3; 4.2, 5.3, and 10.2 kg) imaging data.ResultsP-CFTAH pump fit in 21 out of 40 patients (fit group, 52.5%) but did not fit in 19 patients (non-fit group, 47.5%). I-CFTAH pump fit all of the 33 patients evaluated. There were critical differences due to dimensional variation (p &lt; 0.0001) for the P-CFTAH, such as body weight (BW), height (Ht), and body surface area (BSA). The cutoff values were: BW: 5.71 kg, Ht: 59.0 cm, BSA: 0.31 m2. These cutoff values were additionally confirmed to be optimal by CT imaging.ConclusionsThis study demonstrated the range of proper fit for the P-CFTAH and I-CFTAH in congenital heart disease patients. These data suggest the feasibility of both devices for fit in the small-patient population

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020