Department Of Cardiac Surgery Research Articles

Low-dose slow infusion thrombolysis in the treatment of prosthetic heart valve thrombosis: a clinical case

Agnė Kraujelytė1, Indrė Justina Ignatavičiūtė1, Vilius Janušauskas2, Aleksėjus Zorinas2, Jurij Šabliauskas3, Donata Ringaitienė3 1Vilnius University, Faculty of medicine, Vilnius, Lithuania. 2Heart and Chest Surgery Center, Cardiac Surgery department – Vilnius University Hospital Santaros Clinics 3Institute of Clinical Medicine- Vilnius University- Faculty of Medicine, Clinic of Anesthesiology and Reanimatology- Vilnius University Hospital Santaros Clinics – Centre of Anaesthesiology- Intensive Therapy and Pain Management, Vilnius, Lithuania. Background and Aims. Describe and present a clinical case of a patient treated with low-dose slow infusion thrombolysis after prosthetic valve thrombosis. Methods. The patient is a 75 year old women treated with low–dose slow infusion thrombolysis in the Resuscitation and Intensive Care Unit II of Vilnius University Hospital. Data was monitored since 2017 till 2020. A detailed analysis of the patient’s life and medical history was made. The course and dynamics of examinations and treatment procedures / medications prescribed to the patient were analyzed in a structured way. The literature on the selected topic is examined in detail in order to compare the efficacy and outcome of low-dose slow infusion thrombolysis with the results of previous studies and in the case we presented. Permission to use patient data has been obtained with the consent of the personal data protection specialist. Patient confidentiality was guaranteed – name, surname, address and other personal data were not collected. The results of the study are published only in a summary form. Results. A 75-year-old patient had a prosthetic mitral mechanical valve in 2009 St. Jude 29 MJ. In 2015, the valve was replaced due to high thrombosis. Since 2016 the woman was hospitalized 4 times (once a year) in December for recurrent mitral valve thrombosis for a low-dose slow infusion thrombolysis procedure. Overall of 12 thrombolysis were performed. Actilyse 25 mg / 6 h was infused with heparin after each thrombolysis for aPTT 50-80 sec. The efficacy of thrombolysis was evaluated by repeated transesophageal ultrasound examinations. The mean pressure gradient dynamics was decreasing (24mmHg 4.3mmHg). A geneticist and hematologist were consulted for suspected thrombophilia that had not been diagnosed, but hyperhomocysteinemia had been identified. 2020 she was hospitalized in July for suspected recurrent MV prosthetic thrombosis, but there were insufficient data on thrombosis, so the patient was admitted to outpatient treatment, recommending a Level III cardiologist consultation twice a year. Conclusions. Low-dose, slow-infusion thrombolytic therapy is currently increasingly being used in patients with prosthetic valve thrombosis. This is because it has safety, efficacy, and a lower incidence of complications. However, this clinical case demonstrates that such treatment does not always prevent recurrence of thrombosis. Keywords: Actilyse, low – dose, slow infusion thrombolysis, prosthetic valve thrombosis. https://doi.org/10.53453/ms.2021.06.20

PREVALENCE OF ACS IN AVICENNA BALKHI TEACHING HOSPITAL IN AFGHANISTAN

One third of global deaths is caused by CVD, and the most common is IHD. Approximately 80% of IHD is caused by atherosclerosis, while the rest ones are caused by non-atherosclerotic diseases such as VHD, radiation, vasculitis, and others.To study the prevalence of ACS in Avicenna Balkhi Teaching Hospital.This is a retrospective cross sectional study. We collected data of 180 patients with ACS from 01.01.2019 to 01.06.2019 in Avicenna Balkhi Teaching Hospital; data were evaluated on the basis of clinical signs, methods of a treatment and outcome in patients with ACS.180 patients with ACS were admitted during the first six months of 2019. From the aforementioned ACS, 62.7% of (113) cases were STEMI and 37.2% of (67) cases were NSTEMI/UA, with a male to female ratio 2.64:1. 66.7% of patients had an age of 60 – 79 years. The mean time of patients’ admission in CCU was 15.5h and was higher in NSTEMI/UA than in STEMI (18.3 h vs 11.8 h) respectively. Treatment of all patients with ACS such as STEMI, NSTEMI, UA was the same in 90% and they received antiplatelet, statins, anticoagulants, anxiolytics. 30,4% of patients with STEMI received thrombolytic therapy with streptokinase (which is available in Afghanistan), just in 10% of 30.4% cases we saw the effective role of streptokinase. The most common comorbidity diseases include: Hypertension 45.6%, DM 22.2%, Smoking 27.8%, Heart failure 21.7%, COPD 5.6%. Most of patients with ACS were STEMI, that were found more in males than in females. More than 50% of patients had an age of 60-79 years old, the mean admission time in the CCU was more than 10, and the most common comorbidities were HTN, smoking, DM and heart failure. The public awareness about heart diseases is increasing, the professional capacity of medical staff is expanding, and equipping of the Cath lab and cardiac surgery department is getting well. Finally, this study will serve as a resource for future research.

Ticagrelor and CABG for acute coronary syndrome?-It is complicated.

Journal of Cardiac SurgeryVolume 36, Issue 8 p. 2802-2804 COMMENTARY Ticagrelor and CABG for acute coronary syndrome?—It is complicated Sigrid Sandner MD, Sigrid Sandner MD orcid.org/0000-0003-4669-9841 Department of Cardiac Surgery, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorMario Gaudino MD, PhD, Corresponding Author Mario Gaudino MD, PhD mfg9004@med.cornell.edu orcid.org/0000-0003-4680-0815 Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York City, New York, USA Correspondence Mario F. L. Gaudino, MD, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th St, New York, NY 10065, USA. Email: mfg9004@med.cornell.eduSearch for more papers by this author Sigrid Sandner MD, Sigrid Sandner MD orcid.org/0000-0003-4669-9841 Department of Cardiac Surgery, Medical University of Vienna, Vienna, AustriaSearch for more papers by this authorMario Gaudino MD, PhD, Corresponding Author Mario Gaudino MD, PhD mfg9004@med.cornell.edu orcid.org/0000-0003-4680-0815 Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, New York City, New York, USA Correspondence Mario F. L. Gaudino, MD, Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th St, New York, NY 10065, USA. Email: mfg9004@med.cornell.eduSearch for more papers by this author First published: 26 May 2021 https://doi.org/10.1111/jocs.15678Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue8August 2021Pages 2802-2804 RelatedInformation

ECHOCARDIOGRAPHIC DIAGNOSIS OF EBSTEIN ANOMALY

This study examined the value of echocardiography in the diagnosis of Ebstein anomaly using data collected from 12 patients with Ebstein anomaly. These patients were hospitalized between March 2015 – October 2019 in the department of paediatric cardiac surgery in Timofei Moșneaga Republican Clinical Hospital, Chisinau Moldova. Their pre-operative echocardiography description of the tricuspid valve and the description of the surgeon from the surgery were compared. Results showed that the data obtained by echocardiography were very similar to the intraoperative findings that were reported by the surgeon in most patients.

Impact of Venoarterial Extracorporeal Membrane Oxygenation on Alkaline Phosphatase Metabolism after Cardiac Surgery.

(1) Alkaline phosphatase (AP) is consumed during cardiopulmonary bypass (CPB). A high AP depletion leads to an impaired outcome after cardiac surgery. However, data is scarce on the postoperative course of AP under venoarterial ECMO (VA-ECMO) support. (2) A total of 239 patients with VA-ECMO support between 2000 and 2019 at the Department of Cardiac Surgery (Vienna General Hospital, Austria) were included in this retrospective analysis. Blood samples were collected at several timepoints (baseline, postoperative day (POD) 1–7, POD 14 and 30). Patients were categorized according to the relative AP drop (<60% vs. ≥60%) and ECMO duration (<5 days vs. ≥5 days). (3) Overall, 44.4% reached the baseline AP values within 5 days—this was only the case for 28.6% with a higher AP drop (compared to 62.7% with a lower drop; p = 0.000). A greater AP drop was associated with a significantly higher need for renal replacement therapy (40.9% vs. 61.9%; p = 0.002) and an impaired 1-year survival (51.4% vs. 66.0%; p = 0.031). (4) CPB exceeds the negative impact of VA-ECMO; still, ECMO seems to delay alkaline phosphatase recovery. A greater initial AP drop bears the risk of higher morbidity and mortality.

Willingness of non-participants of conventional cardiac rehabilitation to participate in cardiac telerehabilitation: results of semi-structured interviews

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) is considered a Class IA recommendation in secondary prevention of ischemic heart disease and heart failure. Participation rates are low however. Telerehabilitation (TR) is widely studied to overcome known barriers. However, the willingness of patients that refuse centre-based CR to participate in TR is scarcely studied. This study aims to assess the willingness to participate in TR in patients that refuse conventional centre-based CR, as well as the main barriers to participation in CR and TR. Methods Patients were screened during hospitalisation on the cardiology, cardiac surgery and cardiac intensive care departments. Patients that were eligible for CR but refused to participate were asked to participate in the study. A semi-structured interview consisting of 18 questions was performed during hospitalisation. After signing an informed consent, interviews were conducted, recorded and analysed. Additional data was extracted and analysed from the hospital electronic health records. Results A total of 20 patients were included. Mean age was 69.6 years (± 10), 17 patients were male (85%), cardiac pathologies were ischemic heart disease (10), heart failure (5) and arrhythmia (5). Six patients (30%) owned a smartphone. Primary reasons not to participate in conventional CR were transport issues (7), lack of motivation (5), cost (3), already being physically active at home (2), or other reasons (3). Eight patients (40%) indicated that, if a programme existed, they would participate in a TR programme. In the group of patients that would not want to participate in TR (n = 12), 10 said lack of digital literacy was a reason, 9 said not having the needed technology (either a computer, a smartphone or both) was a reason. Five said that lack of motivation was a reason and 3 didn’t see the utility of doing rehabilitation at home or rehabilitation at all. The most important reason not to participate was a lack of digital literacy in 6 patients, and a lack of motivation or not seeing the utility of rehabilitation in 6 patients. In the group of patients that would participate in TR, all 8 said that not needing transport was an advantage, 2 indicated that being able to perform rehabilitation on flexible hours was an advantage. All 8 indicated that not needing transport was the main advantage of TR for them. The most important barrier for this group was not being fluent with computers and/or smartphone (3). Conclusions Of a group of patients not willing to participate in conventional CR, 40% would be prepared to participate in TR. Lack of digital literacy and lack of motivation were the main reasons not to participate in TR. Not needing transport was seen as the main advantage of TR. Further research in larger populations will be needed to confirm these results.

Spectrum of Quality of Life after Valve Surgery in Patients with Rheumatic Heart Disease.

Background and Aims: Improvement in quality of life is one of the principal goals of valve surgery. The purpose of this study was to assess the quality of life in patients living with mechanical heart valves.&#x0D; Methods: We conducted a cross-sectional descriptive study among 131 (42 Males, and 89 Female) patients, who had undergone valve procedures at different times in clinic visit of department of cardiac surgery, unit I of Shahid Gangalal National Heart Centre from August 1 till August 29, 2019. Quality of life index was measured using Ferrans and Power quality of life index, cardiac version IV via written questionnaire or verbal interview.&#x0D; Results: Mean age was 40.57±1.4 (16-75) years. Mean duration of follow up was 4.68±4.03 years (3 months to 18 years). Subjects reported the lowest quality of life scores in the health and functioning domain prior to surgery (15.61±1.30), which improved 47.15% after surgery (22.95±0.45), psychological/spiritual domain improved 16.68%, social and economic domain 26.24%, family domain 11.49%, with overall improvement 28.62%. Women had significantly lower mean overall quality of life index (22.99±03.58) (95% confidence interval 22.24-23.75) compared to male counterparts (24.21±4.11) (95% confidence interval 22.92-25.49) (p&lt;0.05). Family domain had the highest score at the latest follow up (28.84±1.63). There was a statistically significant correlation between the duration of operation and overall quality of life index (Pearson's rho 0.217, p&lt;0.01). There was no significant difference with the patients’ age.&#x0D; Conclusion: This study confers significant improvement of quality of life after valve surgery with time. Age does not appear to limit the quality of life. Family support seems to be the biggest strength in our population.

Impact of rescue collapse on mortality rate in severe accidental hypothermia: A matched-pair analysis

AimTo assess the impact of the occurrence of cardiac arrest associated with initial management on the outcome of severely hypothermic patients who were rewarmed with Extracorporeal Life Support (ECLS). MethodsWe collected the individual data of patients in a state of severe accidental hypothermia who were found with spontaneous circulation and rewarmed with ECLS, from cardiac surgery departments. Patients were divided into two groups: those with a subsequent cardiac arrest (RC group); and those with the retained circulation (HT3 group), and compared by using a matched-pair analysis. The mortality rates and the neurological status in survivors were compared as the main outcomes. The difference in the risk of death between the HT3 and RC groups was calculated. ResultsA total of 124 patients were included into the study: 45 in the HT3 group and 79 in the RC group. The matched cohorts consisted of 45 HT3 patients and 45 RC patients. The mortality rate in both groups was 24% and 49% (p = 0.02) respectively; the relative risk of death was 2.0 (p = 0.02). ICU length of stay was significantly longer in the RC group (p < 0.001). Factors associated with survival in the HT3 group included patient age, rewarming rate, and blood BE; while in the RC group, patient age and lactate concentration. ConclusionsThe occurrence of rescue collapse is linked to a doubling of the risk of death in severely hypothermic patients. Procedures which are known as potential triggers of rescue collapse should be performed with special attention, including in conscious patients.

Prime Risk Factors to Act as Biomarkers for the Diagnosis of Myocardial Infarction

Aims: This study was done to find out retrospective case-control with respect to myocardial infarction diagnosis on the basis of biochemical markers and lipid profile characteristics.&#x0D; Design and Setting: This study was conducted at the Department of Biochemistry and sample collection at LPS Institute of Cardiology &amp; Cardiac Surgery Department, Kanpur.&#x0D; Methods: The total number of subjects participated in this study (n=178), of either sex (with age&gt;65years) were included in this study from the case collected from Outpatient Department (OPD) and Indoor Patient Department (IPD) and control from patients attendant, which consisted of two subject groups: The group I: myocardial infarction (cases) n= 89 and Group II: Healthy Subjects (controls) n= 89. Laboratory methodology was performed to determine the prime important risk factors such as body mass index (BMI), blood pressure and lipid profile characteristics associated with myocardial infarction. Risk factors were analyzed by Chi-square and Pearson correlation, receiver operating characteristic (ROC) curve method considered significant when the critical, P &lt;0.01level was set up, for a 95% confidence interval.&#x0D; Results: Total number of (n=178) participants (males=65; mean age of 65 years, females=24, mean age of 58 years) at 95% CI were considered in this study, out of these, 89 individuals were expected to have risk of myocardial infarction (especially observed in case groups), and remaining 89 individuals were considered as control groups, all were included as, study subjects.&#x0D; Conclusion: The current study concludes the importance of myocardial infarction in presence of prognostic inflammatory markers: higher IL-6 and plasma fibrinogen level, instead of high-sensitivity C-reactive protein, incase and control groups.

Effect of Intact Pleura on Early Outcome after Off-Pump Coronary Artery Bypass Grafting

Background: Among the various options of treatment of ischemic heart disease coronary artery bypass grafting (CABG) remains one of the standard modes of revascularization. Coronary artery bypass grafting can be done with or without using cardiopulmonary bypass (CPB). This study was to compare postoperative early (up to 1 month) outcome of intact versus open pleura after off pump coronary artery bypass grafting (OPCAB).&#x0D; Methods: In this study, sixty patients aged 18-70 years admitted in Department of Cardiac Surgery, NICVD who underwent OPCAB were selected for the study sample and divided into two groups. Groups I (n=30) consist of the patients who underwent OPCAB with pleurotomy and Group II (n=30) consists of patients who underwent OPCAB with intact pleura. Outcome of patients including Forced expiratory volume in first second (FEV1) &amp; Forced vital capacity were evaluated.&#x0D; Results: Patients having OPCAB with intact pleura showed lower incidence of atelectasis and pleural Effusion in 2nd postoperative &amp; 5th postoperative day (p&lt;0.05). Lower amount of chest tube drainage and transfusion requirement were observed in group II patients than Group I (530.00 ± 28.97 vs. 485.96±38.62; p&lt;0.05 and 611.23±99.22 vs. 577.93±135.38, p&gt;0.05, respectively). Moreover, higher duration of ventilation were noted in group I (7.50 ± 2.22 vs. 6.30±2.32, p&lt;0.05). Beside these, total duration of ICU stay &amp; hospital stay were significantly higher in patients OPCAB with open pleura (p&lt;0.05).&#x0D; Conclusion: Keeping the pleura intact during OPCAB is significantly associated with low rate of atelectasis and pleural effusion. Clinically, it decreases postoperative amount of blood loss and significantly lowers ICU stay, mechanical ventilation time and hospital stay. Therefore, it can be concluded that intact pleura during OPCAB improves postoperative pulmonary outcomes.&#x0D; Cardiovasc. j. 2021; 13(2): 112-119

Cardioprotection with Adenosine during Coronary Revascularization

Background: Postoperative cardiac dysfunction is a common cause of mortality and morbidity associated with CABG Surgery. Adenosine enhances tolerance of the myocardium to ischemic arrest. Therefore, the study on adenosine pre-treatment as an adjunct to cardioplegia in patients undergoing CABG will definitely help to provide better myocardial protection for better postoperative outcome.&#x0D; Methods: Quasi experimental study was done in the Department of Cardiac Surgery, NICVD during July 2012 to June 2014 with patients who underwent conventional CABG surgery. Patients were divided in two groups. Group A: Patients received at regular institutional high-potassium ([K+] = 20 mol/ l) cold (12 °C) blood cardioplegia. and Group B: Patients received 250 μg /kg bolus dose of adenosine pre-treatment, which was immediately followed by high-potassium cold (12 °C) blood cardioplegia after clamp-on. Patients were followed up to evaluate the degree of myocardial damage by measuring perioperative Troponin I, amount of inotropic support, time of assisted ventilation, arrhythmia and mortality.&#x0D; Results: Most of the patients in each group belongs to 51-60 years of age range. There was no difference regarding operative parameters in two groups. Time to arrest was significantly shorter in group B compared to group A, indicating that adenosine has the potential to enhance the efficacy of cardioplegic arrest. Plasma level markers of myocardial damage: cardiac Troponin I (cTnI) obtained from serial venous blood samples post-operatively were significantly lower in group B than group A (p&lt;0.05). There was significantly decreased requirement of inotrope in group B during first 24 hrs (p &lt;0.05).&#x0D; Conclusion: Decreased level of cardiac enzymes and lower inotropic requirement suggests that an optimal myocardial protection with less cellular damage is obtained with adenosine pre-treatment as adjunct to cold blood cardioplegia.&#x0D; Cardiovasc. j. 2021; 13(2): 128-134

Early Outcome of Minimally Invasive Direct Coronary Artery Bypass Surgery- A hospital based study

Background: coronary artery bypass surgery (CABG) is expensive, uses disposable appliances and patients require more perioperative intensive care, long stay in hospital and often have a lengthy recovery time. These complications, together with the growing trend towards less invasive techniques in other areas of surgery, have encouraged cardiac surgeons to see if minimally invasive cardiac surgery can become a reality with improved outcomes and costs.&#x0D; Methods: This is a prospective nonrandomized comparative clinical study done at the Department of Cardiac Surgery in National Institute of Cardiovascular Diseases (NICVD) Sher-E- Bangla Nagar, Dhaka from July 2006 to June 2008 among routine CABG patients. Purposive sampling was done with 26 patients in group A selected for MIDCAB and 24 patients in Group B selected for conventional CABG surgery. Patients were followed up for three months. Postoperative outcomes were assessed to evaluate the safety and efficacy of MIDCAB in relation to conventional CABG.&#x0D; Results: Mean age were 54.19 vs 53.87 in group A and Group B. 92.3% vs 87.5% were male respectively. Mean duration of operation, per operative blood loss transfusion and arrythmia were lower in MIDCAB group (p&lt;0.05) number of grafts were also statistically significant (p&lt; 0.001). Regarding post-operative outcome ventilation time in hours ICU stay post-operative hospital stay in days, postoperative MI and stroke rate were lower in favor of group A MIDCAB patients (p&lt;0.001). Three months postoperatively six-meter walking distance is also statistically significant in favor of Group A MIDCAB (p&lt;0.01) patients. However, pain score in early post-operative period was higher in group A significantly but it decreased significantly in late post-operative period which is also highly statistically different (p&lt;0.001). However, mortality and quality of life at three months were similar in both groups.&#x0D; Conclusion: No difference in mortality rates detected between MIDCAB and CCABG group. But there was evidence that MIDCAB is associated with less perioperative and early postoperative morbidity and improved quality of life. The MIDCAB surgery is an effective procedure of complete revascularization in ischemic heart diseases like CCABG. The procedure is associated with shorter operating time, shorter ICU stay time, shorter hospital stays and better quality of life than for CCABG.&#x0D; Cardiovasc. j. 2021; 13(2): 135-143

Short Term Outcome of Double Valve Replacement vs. Aortic Valve Replacement with Mitral Valve Repair in Bangladesh: A Comparison

Background: Although all mitral valves are not repairable, most non rheumatic valves and a substantial proportion of rheumatic valves are amenable to repair. Repair preserves the normal valvular tissue, so the left ventricular function is well maintained post-operatively. Combined aortic and mitral valve surgery is associated with increased mortality and morbidity. Several studies have shown the superiority of DVR (Double valve replacement) in this entity to prevent reoperation. Some other data suggested superiority of aortic valve replacement combined with mitral valve repair in double valve disease. No study had been done over Bangladeshi population. Our aim was to compare the short-term outcome of mitral valve repair and aortic valve replacement with double valve replacement.&#x0D; Methods: It was a prospective non-randomized observational study took place in the Department of Cardiac Surgery of National Institute of Cardiovascular Disease. In this study post-operative result of double valve replacement was compared with aortic valve replacement and mitral valve repair. Total 60 patients under went aortic valve replacement with either mitral valve replacement (n=30) marked as group A or (n=30) repair marked as Group B.&#x0D; Results: Aortic cross clamp time and cardiopulmonary bypass time was higher in group B than group A but it was well tolerated without any short-term measurable consequences. Required inotrope support was 49.8±2.3 hours in group B and 87.2±3.5 hours in group A (p&lt;0.05). Duration of ICU stay were 91.1±3.2 hours in group A and 60.3±2.9 hours in group B (p&lt;0.05). Development of postoperative low output syndrome was significantly higher (23.33%) in group A versus 3.33% in group B. Patients of group A suffered more from CHF in the follow up period than the group B. But the result was statistically insignificant. There was an early post-operative fall of ejection fraction in both groups but it was recovered after 3 months. Post-operative thromboembolism was 13.79% in group A and 3.33% in group B. There was no early death in repair group though total three (10%) cases died after DVR. There was no valve failure, re-stenosis or regurgitation in any group in this limited follow up period. Higher dose of warfarin was required in group A to maintain INR. Consequently, post-operative major bleeding occurred in 24.14% patients of group A. On the contrary, no patient of repair group suffered from this catastrophe.&#x0D; Conclusion: This study reveals that the result of mitral valve repair with aortic valve replacement is equally comparable or in some cases superior to that of double valve replacement. Therefore, in feasible cases, mitral valve repair should be attempted who need concomitant aortic valve replacement.&#x0D; Cardiovasc. j. 2021; 13(2): 164-171

Cardiac surgery during COVID-19 pandemic: preliminary results and insights

Background: Elective cardiac surgical operations were resumed after a period of decline of infection rate of COVID-19 pandemic. Guidelines and recommendations are formulated for safe resumption. The aim of this study was to present our experience of reopening of cardiac surgical activities.Methods: A double-centered prospective longitudinal study was performed in cardiac surgery departments at Zagazig University hospitals and Nasser Institute starting from 1st July to 15th September. COVID PCR swab and CT chest were done for all patients and positive cases were postponed. Safety measures were strictly followed. We applied a strategy for patient selection and recruitment of medical staff for surgical activities.Results: Sixteen patients were positive for COVID-19 and not admitted. We operated 177 patients (165 elective, 12 emergent). Two patients were found positive postoperatively and died from pulmonary complications. One surgeon was infected and survived.Conclusion: preliminary results of resuming cardiac surgical activities were encouraging. Strict adherence to preventive measures and adopting appropriate strategy for patient selection are crucial for safety of patients and health care givers.

Role of fast tract Extubation in Enhanced Recovery after Cardiac Surgery: Associated Factors and Outcomes

Objective: To assess the impact of fast track extubation versus late extubation in cardiac surgery patients being operated in Bahawal Victoria hospital, Bahawalpur, Pakistan.Methods: This analytical cross-sectional study was conducted in department of cardiac surgery, Bahawal Victoria Hospital, Bahawalpur, from March 2018 to March 2020. All patients who underwent cardiac surgical procedures were consecutively enrolled. Fast-track extubation (FTE) and delayed extubation (DE) in these patients were recorded. Moreover, information regarding baseline and clinical characteristics was collected and outcome like reintubations, hospital stay, and mortality were observed.Results: Of 86 patients, FTE was successful in 70 (80.14%) patients, while DE was observed in 16 (18.6%) patients. High dose inotropes 6 (37.50%) and increase drain output 5 (31.25%) were the most common cause of FTE failure among 16 patients. NYHA class was found to be significantly higher in DE group as compared to FTE group (pvalue 0.002). The mean ventilation time in FTE group was significantly higher as compared to DE group, i.e., 2.7±1.6 hours vs. 6.5±4.4 hours respectively (p-value 0.001). While, inotropic support (p-value 0.047), drain volume at 4 hours (p-value 0.039), and drain at the time of removal (p-value 0.002) were significantly lower in FTE group as compared to DE group. There was a single reintubation (1.16%) and mortality (1.16%).Conclusion: FTE is a safer technique in planned cardiac surgical procedures resulting in least morbidity and mortality.

Effectiveness of posterior pericardiotomy in preventing cardiac tamponade and effusion pericarditis in the early period after interventions on the thoracic aorta

Background. Interventions on the thoracic aorta involving prolonged artificial circulation, clamping of the aorta and extensive dissection of the mediastinal structures are associated with a higher incidence of pericardial effusion and cardiac tamponade compared to other interventions. We suggest that routine implementation of posterior pericardiotomy may significantly affect the incidence of postoperative pericardial effusion syndrome and cardiac tamponade after interventions on the thoracic aorta.Aim. Evaluation of the effectiveness of posterior pericardiotomy regarding the development of cardiac tamponade, effusion pericarditis and the postoperative course of patients in the early period after interventions on the thoracic aorta.Methods. We conducted a retro- and prospective study that included 100 patients with thoracic aorta pathologies who were operated on in the cardiac surgery department of clinic from 2017 to 2020. All subjects were divided into two groups: a treatment group of 40 patients who underwent routine posterior pericardiotomy, and a control group of 60 patients without posterior pericardiotomy but with standard installation of postoperative drains. Assessment of the effect of posterior pericardiotomy on pericardial effusion, cardiac tamponade and the early postoperative period was conducted on the basis of transthoracic echocardiography that was performed daily during hospitalisation (the maximum amount of effusion during the observation period was taken as the control point), as well as up to one month after discharge from hospital.Results. The study groups did not differ regarding parameters such as time of artificial circulation (p = 0.39), time of myocardial ischaemia (p = 0.42), length of intensive care unit stay (p = 0.79) and length of hospitalisation (p = 0.21). Evaluation of pericardial effusion of varying severity during hospital follow-up revealed its presence in 15 (37.5%) patients in the PPt group and in 54 (90%) in the control group (p = 0.0001). Early postoperative cardiac tamponade developed in 4 (6.7%) patients in the control group, but was not observed in the PPt group (p = 0.09). At the same time, 5 (8.3%) patients without pericardiotomy required pericardiocentesis; however, this procedure was not performed in the PPt group (p = 0.06). Additionally, we did not find a statistically significant difference between the groups in relation to the frequency of puncture of the left pleural cavity (37.5% in the PPt group versus 43.3% in the control group, p = 0.56). According to the results of control echocardiography after one month, effusion of varying severity was found in 21 (35%) patients in the control group versus 1 (2.5%) in the PPt group (p = 0.0001).Conclusion. Posterior pericardiotomy is an affordable, applicable, safe and effective method for preventing postoperative pericardial effusion and cardiac tamponade after thoracic aortic surgery. This manipulation did not significantly affect the length of hospitalisation or the incidence of postoperative atrial fibrillation in this cohort of patients. Posterior pericardiotomy is not associated with a more frequent need for puncture of the left pleural cavity. Received 13 October 2020. Revised 10 December 2020. Accepted 11 December 2020. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest.

Conventional Weight-Based versus Low-Dose Regimen of Heparin Administration to Achieve Target Activated Clotting Time on Cardiopulmonary Bypass in Pakistani Population

Objective: A weight-based dose of heparin is calculated to achieve target ACT (Activated clotting time) for establishing CPB (cardiopulmonary bypass). Whether a target ACT can be achieved with lower dose of heparin in Pakistani population was the aim of this study.&#x0D; Methodology: The cross-sectional comparative study was conducted at Rawalpindi Institute of Cardiology, Department of Cardiac Surgery from 1st January 2019 to 1st January 2020. Three hundred thirty-six (336) patients undergoing elective open-heart surgeries on CPB were included in this study. Patients receiving weight-based heparin dose were placed in Group-A, while those on low-dose heparin were placed in Group-B. ACT was considered to have reached the target value in range of 400-480 seconds, values between 481-1500 seconds were considered excessive, whereas ACT of &gt;1500 was regarded as potentially high-risk for peri-operative bleeding .&#x0D; Results: 14.1% (n= 28) of Group-A patients achieved target ACT, whereas 58.3% (n=116) exceeded the target of 480. In 25.1% (n=50), ACT values were beyond the measuring capacity of the assay machine i.e. &gt;1500. Only 2.5% (n=5) required additional dosage of heparin. Target ACT in Group B was achieved in 19.7% (n= 27), 55.5% (n=76) had excessive ACT values, whereas in 16.8% (n= 23), it was &gt;1500. 9.5% (n=13) required an additional dosage of Heparin.&#x0D; Conclusion: In Pakistani population, a target ACT can be achieved with significantly lower dose than the conventional weight-based heparin dose. Larger studies, preferably randomized controlled trials are needed to determine the optimal heparin dose calculation for safe anti-coagulation during CPB.

Validation of EuroSCORE II to predict mortality in post-cardiac surgery patients in East Java tertiary hospital

BACKGROUND The European system for cardiac operative risk evaluation (EuroSCORE) II is one of the established risk models used to predict mortality after cardiac surgery. However, its application as a mortality predictor for Indonesian adult cardiac surgery is still unknown. This study aimed to examine the validation of EuroSCORE II in predicting the mortality following adult cardiac surgery in Indonesian adults.&#x0D; METHODS This retrospective cohort study collected data from the medical records and the database of the Department of Thoracic Cardiac and Vascular Surgery at Soetomo General Hospital, Surabaya. Data on the EuroSCORE II variables were collected for patients aged &gt;18 years who underwent coronary artery bypass, heart valve, heart tumors, aortic surgeries, or a combination of these surgeries between January 2016 and December 2018. In-hospital mortality prediction was calculated using the online calculator at www.euroscore.org. The calibration of the EuroSCORE II model was conducted using the Hosmer–Lemeshow test, and discrimination analysis was done using receiver operating characteristic (ROC) curves with area under the ROC curve (AUC) calculation.&#x0D; RESULTS A total of 213 patients met the inclusion criteria and were analyzed for this study. Mortality was 8.9%. The predicted and actual mortalities were 1.74% and 8.9%, respectively. The significance (p-value) of the Hosmer–Lemeshow test was 0.55, indicating good calibration. The AUC of ROC curve was 0.85 (95% CI = 0.77–0.92, p&lt;0.001), suggesting good discrimination.&#x0D; CONCLUSIONS EuroSCORE II has a good calibration and discrimination for cardiac surgery in Indonesian adults.

One-stage surgery in patients with both cardiac and non-cardiac diseases

Objective To investigate the possibility and feasibility of one-stage cardiac and non-cardiac surgery. Methods From July 1999 to August 2018, one hundred and eleven patients suffering from cardiac and non-cardiac diseases were treated by one-stage cardiac and non-cardiac operation in Department of Cardiac Surgery and Thoracic Surgery, General Surgery, Urinary Surgery, and Gynecology, Peking University First Hospital. There were 83 males (74.8%) and 28 females (25.2%), aged 41 to 84 years [mean age: (64.64±8.97) years]. The components of the cardiac disease included coronary heart disease, valvular heart disease, cardiac tumors, chronic constrictive pericarditis and congenital heart disease. The components of the non-cardiac diseases included lung benign and malignant diseases, thymoma and thymic cyst, breast cancer, chest wall giant hemangioma, digestive tract benign and malignant diseases, urinary system carcinoma and gynecological diseases. Results Two patients died after operations in hospital; thus, the hospital mortality rate was 1.8%. One patient died of multiple organ failure on the 153th days after emergency coronary artery bypass grafting (CABG) combined with radical resection of bladder cancer. The other of pericardium stripping with lung cancer operation died of the multiple organ failure on the tenth day after surgery. The remaining 109 patients recovered and were discharged. There were 13 cases of complications during the days in hospital. The total operative morbidity was 11.7%: postoperative hemorrhage in 2 cases (1.8%), pulmonary infection and hypoxemia in 3 cases (2.7%), hemorrhage of upper digestive tract in 1 case (0.9%), incisional infection in 3 cases (2.7%), subphrenic abscess in 1 case (0.9%), and postoperative acute renal failure and hemofiltration in 3 case (2.7%). Of the 109 patients discharged, 108 patients were followed up. All the patients survived for 6 months, and 21 patients died due to tumor recurrence or metastasis within 1 to 5 years of follow-up, but no cardiogenic death. During the follow-up period, 1 patient developed cardiac dysfunction, 1 patient underwent percutaneous coronary intervention (PCI), 1 patient had cerebral hemorrhage due to excessive postoperative anticoagulation, and 1 patient suffered from incisional hernia. Conclusion One-stage surgeries in patients suffering from both cardiac and non-cardiac benign or malignant diseases are safe and possible with satisfactory short-term and long-term survival.

A Single-Center Experience with Lung Transplants During the COVID-19 Pandemic.

BackgroundThis single-center study analyzed distinctions between lung transplants performed in the Department of Cardiac and Vascular surgery of the University Clinical Center in Gdańsk, Poland before and during the COVID-19 pandemic.Material/MethodsThere were 189 patients who underwent the qualification procedure to lung transplantation in the Department of Cardiac and Vascular Surgery of the University Clinical Center in Gdańsk, Poland in the years 2019 and 2020. The control group consisted of 12 patients transplanted in 2019, and the study group consisted of 16 patients transplanted in 2020.ResultsDuring 2019, the qualification process was performed in 102 patients with pulmonary end-stage diseases. In 2020, despite the 3-month lockdown related to organizational changes in the hospital, 87 qualification processes were performed. The mortality rate of patients on the waiting list in 2020 was 14.3% (6 patients died), and during 2019 the rate was also 14.3% (4 patients died). Donor qualifications were according to ISHLT criteria. The distribution of donors in both years was similar. There was no relationship between the geographic area of residence and source of donors. In 2019, all 12 patients had double-lung transplant. In 2020, 11 patients had double-lung transplant and 5 patients had single-lung transplant. There was no difference in ventilation time and PGD aside from a shorter ICU stay in 2020.ConclusionsLung transplants were relatively well-conducted despite the continued obstacles of the COVID-19 pandemic.