Mitral Valve Replacement Surgery in Redo Patients with Mix Blood Cardioplegia (MBC) Protection

Aim of Study: Redo patient undergoing valve surgery are always a challenge for both cardiac surgeon and anesthesiologists. Mix blood cardioplegia has had a profound impact on cardiac surgery. but there have been few studies on its use in mitral valve replacement, especially in redo patient. The purpose of this study was to determine whether mix blood cardioplegia offers any advantages in redo patient undergoing mitral valve replacement.Patients and Methods:  20 patient, who have had a previous mitral valve surgery and were scheduled for mitral valve replacement with or without tricuspid repair, were randomized retrospectively to one of two groups of 10 with different technique of myocardial protection: group A (10 patients) had cold crystalloid cardioplegia, and group B(10 patients) had mix blood cardioplegia, a technique modified on our clinic condition (made by mixing  400-500ml oxygenated blood from oxygenator  and 10ml KCL 7.5%) . Systemic hypothermia was 28°C in Group A and between 32°C and 33°C in Group B. The results were primarily assessed on the basis of clinical outcome, such as hematocrit level intra and post CPB, maximum dose of inotropic support, spontaneous rhythm recovery after aortic cross clamping, length of intensive care unit stay and secondly on postoperative blood loss and blood requirements. Results: There were no preoperative or operative differences between the groups with regard to age, sex, diagnosis, rhythm, New York Heart Association functional class, left ventricular ejection fraction, estimated pulmonary artery systolic pressure, operation, or duration of the operation, CPB, or aortic cross clamping and the time when the patients underwent the first operation. There was one death in group A (10% mortality). The changes in hematocrit level differs significantly between the two groups on the post CPB period (p=0,02) There appeared to be a trend towards better spontaneous recovery of sinus rhythm after removal of the aortic cross clamp in group B compared with group A, the difference did reach statistical significance. (p=0.002). Patients on group A required more inotropic support than Group B (p=0.005). There were differences even on blood requirements postoperatively, more dominant these  requirement were in group A (p=0.02).Discussion: Mix Blood Cardioplegia had beneficial effects in clinical outcome in redo patients undergoing mitral valve replacement surgery. This may be due to its better preservation of high-energy phosphates and endogenous amino acids, less anerobic metabolic activity on reperfusion, reduced release of cardiac troponin T, and improved post-ischemic functional recovery. Keywords: Miocardial protection, cardiopulmonary bypass CPB, Mix Blood Cardioplegia (MBC) DOI: 10.7176/ALST/82-04 Publication date:October 31st 202

Idiopathic atrial flutter AFL in neonates (Case Report)

Atrial flutter AFL is a rare arrhythmia in the neonate and early infants. Here we report the case of a term female infant (A.K), with a birth weight of 3000 g, who was delivered by Cesarian section of a 26-year-old primiparous mother (I.K) in “Queen Geraldine” Maternity in Tirana. The APGAR scores were 9 and 10 at 1st and 5th minute, respectively. In prenatal history, no fetal arrhythmia was present. After waters breaks, a fetal arrhythmia was detected. Then the infant was delivered by an urgent C section. The infant was treated by medical treatment, which resulted unsuccessful. In the 16th day of life, the DC shock was applied and a sinus rhythm was detected immediately. Neonate: A.K Mother: I.K Keywords: infant, atrial flutter, antiarrhythmic, DC shock DOI: 10.7176/ALST/80-05 Publication date: July 30th 202

Acute Traumatic Pericardial Tamponade.

Acute traumatic pericardial tamponade is a serious and rapidly fatal injury. As penetrating chest wounds are becoming more cammon, early diagnosis of tamponade is important so that life savingtreatement can be started. The classical features of tamponade may a be modified by hypovolemia and the presence of associated injuries. Acute tamponade may also be precipitated by rapid administration of large volumes of fluid. Echocardiography is limited by availability and operator dependence. Pericardiocentesis, while sometimes life saving is dangereous and limited value. A higher deagree of clinical suspincion in patients with chest injuries, together with close monitoring and revaluation, particulary during volume remplancement is essential. This paper describes one patient presented to the emergency department of University Hospital Center “Mother Theresa “ and it discusses the epidemiology and management principles of acute tamponade

Atrial Fibrillation following CABG Surgery. Our Experience with 100 Patients

Introduction: Atrial fibrillation (AF) is the most common complication of cardiac surgery, occurring in 10-40% of patients. Postoperative AF (POAF) refers to new-onset AF in a patient without a history of AF that occurs within the first four weeks after cardiac surgery. While POAF can be transient and without consequences, it may lead to severe complications, increasing mortality and morbidity in the postoperative period. Risk factors can be patient-related, intraoperative, and postoperative. This study aimed to estimate the frequency of AF in patients after CABG combined with valvular replacement or not. Identification of patients vulnerable to arrhythmia will allow targeting of those most likely to benefit from prophylactic therapy.  Material and Methods: The presented study is a prospective study of 100 patients undergoing elective CABG from February to April 2022 with a mean age of 66 ± 13 years, 30% women, undergoing CABG at the University Hospital Centre “Mother Teresa” Tirana, that developed POAF. Results: Postoperative atrial fibrillation occurred in sixteen patients (16%) at a median of 3.7 days after cardiac surgery (2nd – 7th day). 94% (15) of POAF occurred in CABG only, and 6% (1) in the combined intervention (AVR et CABG). Conclusion: AF is the most common complication after CABG. The occurrence is not dependent on the type of intervention (only CABG or combined with valve replacement), the number of vessels that underwent bypass grafting, or the type of vessel. Electrolytic imbalance should be assessed during the postoperative course of patients who undergo CABG.

Management Strategy of Hyperthermic State in Critically Ill Patient.

Pyrexia is a protective physiologic response of the body against external and internal aggression. Temperature control is safe in and effective in septic shock but remain controversial in sepsis. Treating pyrexia to reduce oxygen consumption appears to have beneficial in cardiac arrest, low cardiac output and acute brain injury. Multiple therapeutic options are available for managing pyrexia, with precise targeted temperaturemanagement. Notably, the use of pharmacotherapy versus surface cooling has not been shown to be advantageous. When these two-therapy failed to control the extra-corporal method of cooling should be started. Renal replacement therapies are not typically indicated for temperature control but, in patients requiring renal support, they contribute to heat loss and participate in pyrexia control. Renal replacement therapies may represent a confounding factor in comparative trials on temperature control

Management of COVID-19 Patient in Cardiac Surgery with Cardiopulmonary Bypass

Introduction: The diagnosis of COVID-19 is quite challenging due to the inconsistent correlation between laboratory findings, radiological imaging, and the clinical picture and contact history of the patient. the patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) face double risk because CBP triggers an intense inflammatory response and the leading cause of mortality in COVID-19 patients is “cytokine storm”. In our institution 15 confirmed cases operated on with open-heart surgery. 9 cases isolated caBg, 4 cases valvular combined with caBg, and 1 valvular disease. Materials and method: all patients undergoing elective or urgent cardiac surgery at “Mother theresa” ’s Hospital from 11 March to 30 november 2020 were included in this study. Patients diagnosed with coViD-19 infection via positive throat swab taken due to clinical suspicion postoperatively were reviewed. Patients characteristics, type of intervention, date of coViD-19 diagnosis.Results: 9 patients (72%) normal recovery, no respiratory failure, only 3-5 days of fever (max 39,4). 3 of them a moderate respiratory failure. 3 patients with severe respiratory failure. only 3 deaths (26,6%).Recommendation: it’s important to a preoperative screening for coViD-19 patients. the outcome of cardiac surgical patients who contracted coViD-19 infection perioperatively is extremely poor. aggressive respiratory assistance (early intubation), high doses of corticosteroids, and anticoagulation, better result

The 6th Albanian Congress of Trauma and Emergency Surgery

After a three-year quarantine from the deadliest global pandemic of the last century, ASTES is organizing to gather all health professionals in Tirana, The 6th Albanian Congress of Trauma and Emergency Surgery(ACTES 2022) on 11-12 November 2022, with the topic Trauma & Emergency Surgery and not only...with the aim of providing high quality, the best standards, and the best results, for our patients ...ACTES 2022 is the largest event that ASTES (Albanian Society for Trauma and Emergency Surgery) has organized so far with 230 presentations, and 67 foreign lecturers with enviable geography, making it the largest national and wider scientific event.The scientific program is as strong as ever, thanks to the inclusiveness, where all the participants with a mix of foreign and local lecturers, select the best of the moment in medical science, innovation, and observation.The scientific committee has selected all the presentations so that the participants of each medical discipline will have something to learn, discuss, debate, and agree with updated methods, techniques, and protocols.I hope you will join us on Friday morning, and continue the journey of our two-day event together

Development of a prediction model for postoperative pneumonia A multicentre prospective observational study

BACKGROUND Postoperative pneumonia is associated with increased morbidity, mortality and costs. Prediction models of pneumonia that are currently available are based on retrospectively collected data and administrative coding systems. OBJECTIVE To identify independent variables associated with the occurrence of postoperative pneumonia. DESIGN A prospective observational study of a multicentre cohort (Prospective Evaluation of a RIsk Score for postoperative pulmonary COmPlications in Europe database). SETTING Sixty-three hospitals in Europe. PATIENTS Patients undergoing surgery under general and/or regional anaesthesia during a 7-day recruitment period. MAIN OUTCOME MEASURE The primary outcome was postoperative pneumonia. Definition: the need for treatment with antibiotics for a respiratory infection and at least one of the following criteria: new or changed sputum; new or changed lung opacities on a clinically indicated chest radiograph; temperature more than 38.3 degrees C; leucocyte count more than 12 000 mu l(-1). RESULTS Postoperative pneumonia occurred in 120 out of 5094 patients (2.4%). Eighty-two of the 120 (68.3%) patients with pneumonia required ICU admission, compared with 399 of the 4974 (8.0%) without pneumonia (P < 0.001). We identified five variables independently associated with postoperative pneumonia: functional status [odds ratio (OR) 2.28, 95% confidence interval (CI) 1.58 to 3.12], pre-operative SpO(2) values while breathing room air (OR 0.83, 95% CI 0.78 to 0.84), intra-operative colloid administration (OR 2.97, 95% CI 1.94 to 3.99), intra-operative blood transfusion (OR 2.19, 95% CI 1.41 to 4.71) and surgical site (open upper abdominal surgery OR 3.98, 95% CI 2.19 to 7.59). The model had good discrimination (c-statistic 0.89) and calibration (Hosmer-Lemeshow P = 0.572). CONCLUSION We identified five variables independently associated with postoperative pneumonia. The model performed well and after external validation may be used for risk stratification and management of patients at risk of postoperative pneumonia