The ARCH Projects: design and rationale (IAASSG 001)

OBJECTIVE A number of factors limit the effectiveness of current aortic arch studies in assessing optimal neuroprotection strategies, including insufficient patient numbers, heterogenous definitions of clinical variables, multiple technical strategies, inadequate reporting of surgical outcomes and a lack of collaborative effort. We have formed an international coalition of centres to provide more robust investigations into this topic. METHODS High-volume aortic arch centres were identified from the literature and contacted for recruitment. A Research Steering Committee of expert arch surgeons was convened to oversee the direction of the research. RESULTS The International Aortic Arch Surgery Study Group has been formed by 41 arch surgeons from 10 countries to better evaluate patient outcomes after aortic arch surgery. Several projects, including the establishment of a multi-institutional retrospective database, randomized controlled trials and a prospectively collected database, are currently underway. CONCLUSIONS Such a collaborative effort will herald a turning point in the surgical management of aortic arch pathologies and will provide better powered analyses to assess the impact of varying surgical techniques on mortality and morbidity, identify predictors for neurological and operative risk, formulate and validate risk predictor models and review long-term survival outcomes and quality-of-life after arch surger

THE LOGISTICAL IMPACT OF SEAMLESS MULTIMODAL TRANSPORT ON GLOBAL SUPPLY CHAINS

Globalisation, nowadays is increasingly affecting all people, countries, and sectors of global economy. The world economy itself has become more integrated, and this in turn means that more and more global supply chains are emerging. The globe is transforming to a single integrated marketplace and supply cham efficiency has become a competitive necessity. As the mission of successful global supply chain management is to create the greater customer value at the lowest total cost, lean, integrated supply chains are the ultimate goal of all the companies operatmg in the global marketplace. Multimodalism which is a revolutionary transport scheme is developed to effectively service the demanding phenomenon of globalisation of business, by integrating and coordinating each mode of transport as an integral part of transport chain. Multimodal transport is considered to be the solution for tiie demanding transportation needs of global movements and modem logistics practices. Therefore the purpose of this project is to show the relation between global trade and seamless multimodalism and how integrated multimodal transport can logistically affect and satisfy the increasing transport needs in global supply chains. The collection of data for this project included research of both primary and secondary sources of data. The collection of primary data has been realised through a series of structured interviews, with experts from the logistics and transport industry. Secondary data have been gathered through library and desk top research, comprising of various academic textbooks, articles in logistics and transport journals, periodicals, magazmes, newspapers, and mtemational organisations' publications. World Wide Web research was of course, one more major element in the process of collecting secondary data. Based upon the persons' mterviews and the extended desk top research, it can be said that seamless multimodalism, as a transport service, combines multiple advantages and it can be considered as pne of the most revolutionary schemes of transport. The results of the research indicated, that although, some improvements and advancements in the multimodal transport sector, still have to be made, when seamless multimodalism is achieved, it surely can act as an integrating tool, which affects directly all the logistical actions of a global supply chain, and therefore can assist the global logistics integration

Effect of continuous veno-venous haemofiltratin on the haemodynamics respiratory prognosis of severely septic patients of the ITV as well as estimation of their cytokine kinetics

Introduction Renal dysfunction and failure is a common consequence of the frequently encountered sepsis affecting critically ill patients. This is managed amongst others with the use of continuous renal replacement methods. This study was intended to explore the effects of CCRT beyond the established therapeutic benefits on the patients’ haemodynamics, organ dysfunction and cytokine kinetics of the SIRS that chracterise this multifacet syndrome. Questions that we set to answer in detail: Does CVVH influence cytokine kinetics for cytokines TNF-α, IL-6 and IL-1β ? How does it affect patient haemodynamics? How does it affect prognosis? We conducted 3 studies: A. Pilot study We measured clearance and concentrations of the cytokines under investigation in multiple blood and ultrafiltrate specimens and varying CVVH settings in 9 septic patients receiving renal replacement for acute renal failure. Results: We confirmed constantly high concentrations as well as brief bursts of cytokine production. The preferred circuit and flow for maximal clearance was set. B. Study no. 2 Hypothesis : Does CVVH improve haemodynamic and respiratory function? Method: 36 patients with severe sepsis were monitored for indices of haemodynamic and respiratory function while on CVVH. The filter was discontinued for 12 hrs for control within the cohort. Results: MAP, SVR and vasopressor requirements improved during CVVH with transient worsening during discontinuation. These differences were more pronounced in the group of patients that survived. C. Study no. 3 Hypothesis: Is the effected imroved haemodynamic status linked with imroved survival when applied as early as possible in patients with renal dysfunction? How does this affect cytokine kinetics? Methods: 30 consecutive patients with severe sepsis and/or septic shock were included in the study. CVVH was instituted as early as possible upon establishment of renal dysfunction. Clinical and laboratory indices of MOF were measured daily and plasma and ultrafiltrate specimens were taken and the investigated cytokines measured. Results: Of the measured indices MAP, SVR, CI as well as Pa02/Fi02 all improved during the course of the study, while in some of them there were also baseline differences (pre-CVVH) between survivors and non-survivors. Cytokine clearance and absorption on the membrane were quantified. Sieving coefficients were calculated for TNF- α and IL-6. A multivariate analysis of statistically significant differences between survivors and non-survivors revealed earlier institution of CVVH in the duration of the septic episode as the strongest predictor of survival

Outcomes after Transcatheter Mitral Valve Implantation: A Literature Review

Mitral valve disease is the most common heart valve disease worldwide. Surgical mitral valve replacement or repair has been an established therapy in patients with severe mitral valve disease for many years. On the other hand, many patients with advanced mitral valve disease and severe comorbidities are treated conservatively and are excluded from the surgical procedure. Furthermore, in patients with severe comorbidities, transcatheter mitral valve repair by edge-to-edge technique with MitraClip or transcatheter mitral valve repair with a non-absorbable ring have been added as therapeutic options over the last few years. Alternative procedures for the treatment of patients with advanced prosthetic or native mitral valve diseases include transcatheter access for replacement or implantation of a new prosthetic valve in the diseased mitral valve. Promising results were published about short-term outcomes of patients who underwent the transcatheter mitral valve replacement. The current view and results of the transcatheter mitral valve implantation in patients with advanced native or prosthetic mitral valve disease are briefly discussed

Predictors of Outcomes after Correction of Acute Type A Aortic Dissection under Moderate Hypothermic Circulatory Arrest and Antegrade Cerebral Perfusion

Abstract Introduction: Hypothermic circulatory arrest is widely used for correction of acute type A aortic dissection pathology. We present our experience of 45 consecutive patients operated in our unit with bilateral antegrade cerebral perfusion and moderate hypothermic circulatory arrest. Methods: Between January 2011 and April 2015, 45 consecutive patients were admitted for acute type A aortic dissection and operated emergently under moderate hypothermic circulatory arrest and bilateral antegrade cerebral perfusion. Results: Mean age was 58±11.4 years old. Median circulatory arrest time was 41.5 (30-54) minutes while the 30-day mortality and postoperative permanent neurological deficits rates were 6.7% and 13.3%, respectively. Unadjusted analysis revealed that the factors associated with 30-day mortality were: preoperative hemodynamic instability (OR: 14.8, 95% CI: 2.41, 90.6, P=0.004); and postoperative requirement for open sternum management (OR: 5.0, 95% CI: 1.041, 24.02, P=0.044) while preoperative hemodynamic instability (OR: 8.8, 95% CI: 1.41, 54.9, P=0.02) and postoperative sepsis or multiple organ dysfunction (OR: 13.6, 95% CI: 2.1, 89.9, P=0.007) were correlated with neurological dysfunction. By multivariable logistic regression analysis, postoperative sepsis and multiple organ dysfunction independently predicted (OR: 15.9, 95% CI: 1.05, 96.4, P=0.045) the incidence of severe postoperative neurological complication. During median follow-up of 6 (2-12) months, the survival rate was 86.7%. Conclusion: Bilateral antegrade cerebral perfusion and direct carotid perfusion for cardiopulmonary bypass, in the surgical treatment for correction of acute aortic dissection type A, is a valuable technique with low 30-day mortality rate. However, postoperative severe neurological dysfunctions remain an issue that warrants further research

Angiographic retrograde filling of all left coronary arterial branches in a patient with chronic total occlusion of left main coronary artery

Abstract A 81‐year‐old female patient was referred in our hospital with episodes of pulmonary edema and had an isolated chronic total occlusion of the left main coronary artery. Coronary angiogram showed total occlusion the left main and filling the left coronary system by collaterals from the right coronary artery