Predictors of poor mid-term health related quality of life after primary isolated coronary artery bypass grafting surgery

Objective: To assess the determinants of poor mid-term health related quality of life (HRQoL) at one year after primary isolated coronary artery bypass grafting (CABG). Methods: 463 patients who underwent primary isolated CABG for multivessel disease and came for their annual follow up at the outpatient clinic during one year at Harefield Hospital, Middlesex, were approached to participate in the present study. Prospective clinical data were collected as part of the clinical care of the patients and were retrospectively analysed when the patients consented to participate in the study at their outpatient visit. After their consent they were given three HRQoL assessment questionnaires. Scores, together with clinical data, were analysed by both univariate and multivariate analyses with regard to poor HRQoL outcome. Results: 437 (94.4%) patients consented to participate in the study and filled in the HRQoL questionnaires. Ten variables were identified in the univariate analysis as potential predictors of poor scores of the physical element of HRQoL; however, only three variables—gastrointestinal problems, congestive heart failure, and type D personality trait—predicted poor physical scores independently. Eleven variables were identified in the univariate analysis as potential predictors of poor scores of the mental element of HRQoL; however, only three variables—peripheral vascular disease, infective complications, and type D personality trait—predicted poor physical scores independently. Conclusion: Preoperative gastrointestinal problems, preoperative congestive heart failure, and type D personality trait were independent predictors of the poor physical component of HRQoL. Peripheral vascular disease, infective complications, and type D personality trait were independent predictors of the poor mental component of HRQoL. Interestingly, patients with type D personality were more than twice as likely to have poor physical HRQoL and more than five times as likely to have poor mental HRQoL

Heterotopic Heart Transplantation: The United States Experience

More than 3 decades have passed since the first heterotopic heart transplantation (HHT) was reported. Nowadays, this surgical technique is used rarely, and only in patients who do not qualify for standard orthotopic heart transplantation (OHT). Current indications mainly comprise refractory pulmonary hypertension and a donor-recipient size mismatch (>20%). The objective of this study was to analyze the United States experience with HHT. The United Network for Organ Sharing (UNOS) database between 1987 and 2007 was analyzed. Patients who underwent heart transplantation were enrolled in this study. Patients with missing transplant dates or history of retransplantation were excluded. A total of 41,379 patients underwent OHT and 178 HHT; 32,361 and 111 patients, respectively, were enrolled. Overall 1-, 5-, and 10-year survival was significantly (P 15 mmHg was 86.6 %, 73.3%, and 57.4% in the OHT and 93.8%, 64.8%, and 48.6% in the HHT group (P = .35). Pretransplant criteria (HHT versus OHT) with statistically significant differences (P < .05) were as follows (mean + SD): recipient weight, 78.9 + 19.9 versus 74.1 + 23.4 kg; recipient height, 174.9 + 13.9 versus 168 + 25.1 cm; and TPG 12.1 + 7.2 versus 9.6 + 6.3 mmHg. The results show that HHT remains a feasible option in a highly selected patient population, with overall good results

Veno-venous perfusion to cool and rewarm in thoracic and thoracoabdominal aortic aneurysm repair

BACKGROUND: Femoro-femoral veno-arterial perfusion is an established circulatory support and cooling method for thoracic- and/or thoracoabdominal aortic aneurysm repair. However, retrograde perfusion through femoral arteries can lead to retrograde cerebral embolization and neurologic dysfunction after surgery. To avoid these complications, we have established a femoro-femoral veno-venous perfusion technique and evaluated its safety and effectiveness in elective and nonelective patients. METHODS: Common femoral veins were cannulated bilaterally percutaneously following systemic low-dose heparinization (100 IU/kg body weight). Venous blood was drained from drainage of the inferior vena cava, and venous return followed through the superior vena cava. After proximal aortic cross-clamping, veno-venous perfusion was switched to veno-arterial antegrade perfusion through the distal descending thoracic aorta to achieve spinal and visceral perfusion or through iliac arteries for distal perfusion combined with selective renovisceral blood perfusion. After completion of aortic repair, the arterial cannula was removed and the patient rewarmed just by switching back to veno-venous perfusion. Gas and temperature exchange as well as relevant hemodynamic parameters were recorded prospectively and analyzed retrospectively in 25 consecutive patients including 15 nonelective cases. RESULTS: Percutaneous insertion of outflow (28F cannula) and inflow (18F cannula) venous cannulae was complication-free and allowed unrestricted perfusion in all 25 patients. Veno-venous perfusion allowed effective cooling (mean body temperature 36.6 ± 0.6°C to 31.6 ± 2.1°C, P = .001 compared with start of cooling) and re-warming (mean body temperature 30.5 ± 3°C to 36.3 ± 0.8°C, P = .03 compared with start of re-warming). Hemodynamic as well as pulmonary parameters remained remarkably stable during surgical dissection and single lung ventilation even in nonelective cases. There was no complication associated with the perfusion technique during surgery. CONCLUSIONS: Transfemoral veno-venous cooling and re-warming results in remarkable hemodynamic stability during open repair of thoracic- and/or thoracoabdominal aortic aneurysms and eliminates the need for retrograde arterial perfusion and its inherent risks