History Of Cardiovascular Surgery Research Articles

Prevalence of Cardiovascular Disease Risk Factors in the Women Population Covered by Health Centers in Ardabil.

Objective This study aimed to determine the prevalence of cardiovascular risk factors in the population of women aged 30 to 60 years covered by health centers in Ardabil. Methods This retrospective descriptive-analytical study was conducted on 1006 women aged 30 to 60 years who were covered by Ardabil comprehensive urban health service centers, and they were selected by using the multistage random sampling method. In the first stage, health centers in Ardabil were divided into five geographical areas, and the population covered by each of the five areas was calculated. In the second stage, the number of samples was allocated as a quota in the regions, and in the third stage, in proportion to the population covered by each center in Ardabil, the samples were selected. Women with one of the conditions of pregnancy, lactation, history of kidney disease, known diabetes under medication, history of hepatitis, history of cardiovascular surgery, and history of cancer were excluded from the research process. Results The average activity of individuals was 24.42 minutes per day. The mean intake of fruits and vegetables was 1.9 ± 0.9 and 2.1 ± 1.07 unit/day, respectively, and meat was 286.6 ± 174.6 grams per week. The mean of HDL, LDL, TG, cholesterol, and FBS were 43.6 ± 10.4, 101.28 ± 26.3, 159.89 ± 54.01, 185.99 ± 37.9, and 94.62 ± 13.3 mg/dl, respectively. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) were 108.14 and 68.26 mmHg, respectively. Conclusions Abdominal obesity (waist above 88), obesity and overweight (high body mass index), high triglycerides, high cholesterol, and LDL and HDL outside the proper range were the most important and risk factors for cardiovascular disease among women.

Pseudoaneurysm after total arch replacement mimicking malignant lymphadenopathy.

Key messagePseudoaneurysm should be considered in the differential diagnosis when the computed tomography (CT) findings show a mediastinal mass in patients with a history of cardiovascular surgery even if such surgery occurred over two decades previously.

Cardiovascular surgery experience does not significantly improve patients' response to stroke.

ObjectivesPatients with a history of cardiovascular surgery are at risk of stroke, and immediately calling emergency medical services (EMS) after stroke onset is crucial to receiving effective reperfusion therapy. We aimed to determine the effect of a history of cardiovascular surgery on patients' ability to recognize stroke and intent to call EMS.MethodsWe performed a cross‐sectional community‐based study from January 2017 to May 2017. A total population of 186,167 individuals, recruited from 69 administrative areas across China, was analyzed. Different multivariable logistic regression models were performed to identify the associations between cardiovascular surgical history and stroke recognition or intent to call EMS, respectively.Results0.1% of the total population had a history of cardiovascular surgery. In the surgery group, the estimated stroke recognition rate (SRR) and correct action rate (CAR) were 84.9% and 74.7%, respectively. The prevalence of cardiovascular risk factors was significantly higher in the surgery group. Cardiovascular surgical history was not associated with recognition of stroke across different models. The surgery group was more likely to call EMS, but the difference was not significant after full adjustment (OR: 1.40, 95% CI: 0.99–1.98, p = .0572).ConclusionsCardiovascular surgical history does not influence patients' likelihood of calling EMS more often at stroke onset. Patients receiving cardiovascular surgeries should be counseled regarding stroke recognition, proper response to stroke, and the importance of controlling risk factors.

Poor management of hypertension is an important precipitating factor for the development of acute aortic dissection.

Hypertension is considered a key risk factor for acute aortic dissection (AAD). However, there is limited evidence demonstrating if hypertension management affects AAD development. The objective of this study was to investigate the role of hypertension management in AAD development in a Chinese population. A total of 825 AAD patients and 3300 age- and sex-matched controls were included. The authors analyzed data on demographics, chronic comorbidities, and hypertension management of all participants. Multiple logistic regression analysis was used to estimate the adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for the relationship between chronic comorbidities, as well as the management of hypertension and AAD risk. After adjusting for other related factors, multivariate logistic regression identified hypertension, chronic kidney disease, Marfan syndrome, history of cardiovascular surgery, and history of smoking as risk factors for AAD. Among the identified risk factors, hypertension was an important and controllable risk factor for AAD development. Thus, the authors further evaluated how hypertension management affects AAD development. A total of 848 controls and 585 AAD patients with hypertension were enrolled in this part of the study. Hypertensive patients with AAD had a longer history, higher stage, poorer medication compliance, and poor control rates of blood pressure, among which poor medication compliance (Irregular vs Regular P<0.001; Never treated vs Regular P<0.001) and uncontrolled hypertension (P<0.001) significantly increased the risk of AAD development. In conclusion, uncontrolled hypertension and poor medication compliance are important precipitating and controllable factors for AAD development.

PHENOMENON OF DEMIKHOV. In the Sklifosovsky Institute (1960–1986). Scientifc Revolution in Transplantation (1960–1964). Achievements of the USA and the USSR in the feld of transplantation and transplant immunity (1962)

Correspondence to: Sergey P. Glyantsev, Prof., Dr. Med. Sci., Head of the Department of the History of Cardiovascular Surgery at A.N. Bakoulev National Medical Research Center for Cardiovascular Surgery, Head of the Medical History Unit within the Medical History Department at N.A. Semashko National Research Institute of Public Health, e-mail: spglyantsev@mail.ru Received: August 08, 2018 Accepted for publication: September 12, 2018 The article presents the evidence of a scientific revolution in transplantology that occurred in the world in 1960-1964 with the shift of the paradigm from the impossibility of homoplastic organ transplants to the hope on their feasibility. It began in 1960 with awarding the Nobel Prize to P. Medawar and F. Burnet for the discovery of artificial immunological tolerance, it had its continuation in 1961–1962 with the advances in experimental transplantation of vital organs undertaken in conditions of mechanical circulation (R. Lower, N. Shumway) and immunosuppression (K. Reemstma), and completed with human transplantations of lung in 1963 and of heart in 1964 (J. Hardy). In those years, the concept of mechanical support for an ill heart by using an implanted mechanical assist device was developed and introduced (1963). But even against that background, V.P. Demikhov's achievements in homologous organ transplantation and the development of biological techniques to overcome tissue incompatibility looked impressive. His highest achievement was the transplantation of a supplemental heart to the dog Grishka in June 1962, and the dog survived with it for 141 days. However, after the discoveries in the field of transplantation immunity, the train of experimental transplantation where V.P. Demikhov was riding, began picking up speed very quickly, and the Soviet surgeons were to jump on its footboard.

Surgical Outcome of Abdominal Aortic Aneurysm Replacement in Patients with Connective Tissue Disorders under 30 Years of Age.

Objectives: Abdominal aortic aneurysm (AAA) in patients <30 years old is relatively rare. We retrospectively analyzed patients <30 years who received an AAA replacement.Materials: Among 3,003 patients who received an AAA replacement during the last 40 years, 10 patients <30 years old were retrospectively reviewed. All patients suffered from a connective tissue disease: eight from Marfan syndrome and two from Loeys–Dietz syndrome. Five patients had a history of cardiovascular surgery. Aortic pathologies were a dissection type in eight patients and a non-dissection type in two. All patients received a graft replacement of infrarenal AAA, with a bifurcated graft in six patients and a straight graft in four.Results: Except for cases that were urgent and emergent, rapid aneurysm expansion was noted in all cases. Mean AAA diameter at surgery was 46.7±9.2 mm. No hospital mortality was recorded. Eight patients required 10 additional cardiovascular surgeries: two root replacements, two total arch replacements, two descending aortic replacements, and four thoracoabdominal replacements.Conclusion: AAA replacement in patients <30 years is safe. In younger patients with a connective tissue disease, AAA should be included in the routine medical check-up, and earlier surgical indication should be considered for its rapid expansion.

Clinical and immunophenotypic characteristics of patients with chromosome 22q11.2 deletion syndrome: a single institution's experience.

Aim:The aim of this study was to identify the clinical and immunologic features of patients with 22q11.2 deletion syndrome who were followed up in our clinic. Thus, it is aimed to identify the syndrome early, choose the right treatment options according to humoral and cellular immunologic analysis, and enlighten how to follow up these kinds of patients with immunodeficiencies.Material and Methods:We retrospectively collected data by reviewing the files of 11 patients with 22q11.2 deletion syndrome who were followed up in our clinic between January 2003 and January 2015. The diagnoses were based on the patients’ clinical, genetic, and immunologic features. Demographic features, family history, initial symptoms on admission, physical findings, and results of immunologic studies of the patients. Age of diagnosis, treatment options, and clinical follow-up were evaluated.Results:The patients’ diagnosis age ranged from 1-11 months and the most common symptoms of admission were cardiac murmur and atypical facial appearance, which were detected during a routine physical examination. All patients had cardiac anomalies, and four patients had a history of cardiovascular surgery. Eight patients (72.7%) had a history of severe infection; recurrent lower respiratory tract infections were reported in six patients (54.5%), pulmonary tuberculosis in one patient (9.1%), and moniliasis resistant to treatment was detected in one patient. None of the patients required intravenous immunoglobulin replacement therapy, and antibiotic prophylaxis was administered to two patients with lymphopenia.Conclusion:22q11.2 deletion syndrome is a multi-systemic disorder that should be evaluated by a multidisciplinary team. It should be kept in mind for patients with neonatal hypocalcemic tetany or recurrent infections or atypical facial appearance with cardiac anomalies. Early diagnosis should lead to immunologic analysis and enable the choice of treatment. Preventive measures against infection is recommended for the patients with incomplete immunodeficiency, and thymus transplantation is recommended for patients with complete immunodeficiency.

Improving the utilization of implantable cardioverter defibrillators for sudden cardiac arrest prevention (Improve SCA) in developing countries: Clinical characteristics and reasons for implantation refusal.

Despite available evidence that implantable cardioverter defibrillators (ICDs) reduce all-cause mortality among patients at risk for sudden cardiac death, utilization of ICDs is low especially in developing countries. To summarize reasons for ICD or cardiac resynchronization therapy defibrillator implant refusal by patients at risk for sudden cardiac arrest (Improve SCA) in developing countries. Primary prevention (PP) and secondary prevention (SP) patients from countries where ICD use is low were enrolled. PP patients with additional risk factors (syncope, ejection fraction<25%, nonsustained ventricular tachycardia [NSVT], or frequent premature ventricular complexes) were further categorized as "1.5 PP patients." Candidates who declined implantation were asked for reasons for refusal. Baseline factors that may have influenced the implant decision were examined using logistic regression. Among 3892 patients, the implant refusal rate was 46.5% among PP patients (n = 2700), and 10.3% among SP patients (n = 1192). The most common refusal reason was inability to pay for the device (53.8%), followed by not believing in the benefits of the ICD (19.4%). Among PP ICD candidates, those with no syncope, no NSVT, no premature ventricular contractions, shorter QRS duration, no atrial arrhythmias, and no left bundle branch block were more likely to refuse implant. Among SP candidates, a history of cardiovascular surgery and no sinus node dysfunction were significant predictors of ICD refusal. Additionally, countries had significant differences in patient refusal rates among PP and SP groups. Implant refusal among PP patients is high in many countries. Increased reimbursement and better awareness of the benefits of an ICD could increase their utilization.

Setting body temperature during aortic arch surgery

Aortic arch surgery has been one of the highest mountains to overcome in the history of cardiovascular surgery. Aortic arch surgery presents several problems, including organ protection, particularly brain protection. Arch replacement would inevitably affect brain function due to cerebral ischemia during manipulation of supra-arch vessels.

Aortic dilatation in Marfan syndrome: role of arterial stiffness and fibrillin-1 variants.

Marfan syndrome (MFS) is an autosomal dominant genetic disorder characterized by aortic root dilation and dissection and an abnormal fibrillin-1 synthesis. In this observational study, we evaluated aortic stiffness in MFS and its association with ascending aorta diameters and fibrillin-1 genotype. A total of 116 Marfan adult patients without history of cardiovascular surgery, and 144 age, sex, blood pressure and heart rate matched controls were enrolled. All patients underwent arterial stiffness evaluation through carotid-femoral pulse wave velocity (PWV) and central blood pressure waveform analysis (PulsePen tonometer). Fibrillin-1 mutations were classified based on the effect on the protein, into 'dominant negative' and 'haploinsufficient' mutations. PWV and central pulse pressure were significantly higher in MFS patients than in controls [respectively 7.31 (6.81-7.44) vs. 6.69 (6.52-6.86) m/s, P = 0.0008; 41.3 (39.1-43.5) vs. 34.0 (32.7-35.3) mmHg, P < 0.0001], with a higher age-related increase of PWV in MFS (β 0.062 vs. 0.036). Pressure amplification was significantly reduced in MFS [18.2 (15.9-20.5) vs. 33.4 (31.6-35.2)%, P < 0.0001]. Central pressure profile was altered even in MFS patients without aortic dilatation. Multiple linear regression models showed that PWV independently predicted aortic diameters at the sinuses of Valsalva (ß = 0.243, P = 0.002) and at the sinotubular junction (ß = 0.186, P = 0.048). PWV was higher in 'dominant negative' than 'haploinsufficient' fibrillin-1 mutations [7.37 (7.04-7.70) vs. 6.60 (5.97-7.23) m/s, P = 0.035], although this difference was not significant after adjustment. Aortic stiffness is increased in MFS, independently from fibrillin-1 genotype and is associated with diameters of ascending aorta. Alterations in central hemodynamics are present even when aortic diameter is within normal limits. Our findings suggest an accelerated arterial aging in MFS.

心血管手術経験をもつマルファン症候群患者の体験

心血管手術経験をもつマルファン症候群患者の体験

Erratum: Relationship of admission mean platelet volume, platelet distribution width and white blood cells with ST resolution in patients with acute ST segment elevation myocardial infarction treated with streptokinase without history of previous cardiovascular surgery.

[This corrects the article on p. 125 in vol. 4, PMID: 23833737.].

Characteristics and outcomes of patients with postoperative cardiovascular pseudoaneurysms

BackgroundData regarding long-term outcomes in cardiovascular pseudoaneurysms are sparse. In patients with prior cardiovascular surgery, we sought to assess characteristics and outcomes in patients with cardiovascular pseudoaneurysms (excluding ischemic left ventricular pseudoaneurysms). MethodsWe included 114 patients (mean age, 57 ± 16 years; 70% were men) with prior cardiovascular surgery who presented with paravalvular (n = 71, 59 aortic and 12 mitral valve) and ascending aortic (n = 43) pseudoaneurysms (27% with systemic infection). Baseline, surgical, and follow-up data were recorded. A composite end point of stroke or death during follow-up was recorded. ResultsAdditive European System for Cardiac Operative Risk Evaluation was high (10%), and 81% of patients underwent another redo cardiovascular surgery. Over a mean follow-up period of 5.2 ± 4 years, there were 37 (32%) composite events (32 deaths and 5 strokes). Within the surgical subgroup, there were 10 (11%) composite events during the in-hospital stay. The 1-, 2-, 5-, and 10-year freedom from composite events were 86%, 82%, 74%, and 55%, respectively. Additive European System for Cardiac Operative Risk Evaluation (hazard ratio, 1.14) and presence of a documented systemic infection (hazard ratio, 3.90) were associated with a higher rate of composite events, whereas subsequent cardiovascular surgery as a time-dependent covariate hazard ratio (hazard ratio, 0.30) was associated with improved freedom from composite events (all P < .05). ConclusionsPatients with a history of cardiovascular surgery in whom cardiovascular pseudoaneurysms subsequently develop have a high rate of short- and long-term adverse events. A higher additive European System for Cardiac Operative Risk Evaluation and documented systemic infection were associated with a higher rate of composite events, whereas cardiovascular surgery (to correct cardiovascular pseudoaneurysms) during follow-up was associated with improved freedom from adverse events.

Surgery for non-small cell lung cancer in patients with a history of cardiovascular surgery

PurposeTo clarify if previous cardiovascular surgery (CVS) affects the postoperative outcome of surgery for non-small cell lung cancer (NSCLC).MethodsWe reviewed, retrospectively, the medical records of 36 patients with a history of CVS, who underwent lung cancer surgery at a single institution (study group; SG) and compared their characteristics and postoperative outcomes with those of patients without a history of CVS history (control group; CG), and also with those of patients with coexisting cardiovascular diseases in the CG (specified control group; SCG). Finally, we used a thoracic revised cardiac risk index (ThRCRI) to evaluate the risk of perioperative cardiovascular events.ResultsThere was a significant difference in the ThRCRI classifications between the SG and the SCG (p < 0.0001). There were no significant differences in the incidence of intraoperative and postoperative complications between the SG and CG, or between the SG and SCG. The 5-year survival rates of the SG, CG, and SCG were 69.3, 73.9, and 65.4 % in all stages, and 83.5, 82.2, and 70.4 % in stage I, respectively.ConclusionsPrevious CVS did not increase the number of perioperative cardiovascular events in this study and had no significant influence on the prognosis of patients undergoing resection of NSCLC.

Houston Hearts: A History of Cardiovascular Surgery and Medicine at the Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital by William L. Winters Jr. (review)

Houston Hearts: A History of Cardiovascular Surgery and Medicine at the Methodist DeBakey Heart and Vascular Center Houston Methodist Hospital by William L. Winters Jr. (review)

History of Cardiovascular Surgery at Toronto General Hospital

The Division of Cardiovascular Surgery at Toronto General Hospital has enjoyed an enviable history of academic achievement and clinical success. The foundations of this success are innovation, creativity and excellence in patient care, which continue to influence the current members of the division.

From Catheters To Ventricular Assist Devices: 60 Years of Cardiovascular Experiences With William L. Winters, JR., M.D.

Automatic typewriters, transistor radios, microfiche, black and white television…while considered high-tech in the 1950s, these technologies seem limited when viewed from the 21st century. The same is true for cardiovascular medicine, which back then relied on electrocardiograms and X-rays for most diagnoses. In the 60 years since, advances in medical capabilities have progressed at a staggering pace. Patient research that once required months poring over paper charts is now reduced to hours using electronic medical record databases. Diagnostic images that once took days to process can now be accessed instantly through ultrasound and magnetic resonance imaging. While a half-century ago no one would have imagined accessing any and all information with a 5-second Google search, so too would noninvasive heart surgery been considered unimaginable. Since the 1950s when he graduated from medical school, William L. Winters, Jr., has been a first-hand witness to breathtaking innovations in cardiovascular medicine-both globally and in Houston. Author of Houston Hearts: A History of Cardiovascular Surgery and Medicine at Houston Methodist DeBakey Heart & Vascular Center and long-time medical editor of the Methodist DeBakey Cardiovascular Journal, Dr. Winters sat down with the journal editors this past April to share his insights from the last half-century of medical practice.

Houston Hearts: A History of Cardiovascular Surgery and Medicine At Houston Methodist Debakey Heart & Vascular Center: From the Michael E. DeBakey, M.D., Distinguished Lectureship Series, presented by William L. Winters, Jr., M.D., Editor, Methodist DeBakey Cardiovascular Journal, on January 19, 2015.

From the Michael E. DeBakey, M.D., Distinguished Lectureship Series, presented by William L. Winters, Jr., M.D., Editor, Methodist DeBakey Cardiovascular Journal, on January 19, 2015

How to educate and evaluate cardiothoracic surgeon

The history of cardiovascular surgery began with the first clinical usage of a cardiopulmonary bypass in 1953. Subsequently, new operations for congenital heart disease, valvular heart disease, ischemic heart disease, aortic disease, and transplantation were developed in a short-time period. Thoracic surgery, as well, was also expanded with the introduction of endoscopic surgery, lung volume reduction surgery, and lung transplantation. In addition, operative results have improved considerably due to findings in new operative procedures and instruments, assist devices, new drugs, and perioperative managements. During a 50to 60-year span, we have experienced the best and brightest time in cardiothoracic surgical advancement. With further progress in cardiothoracic surgery being developed, there will be an increase in need for greater technical skills and the education of said skills. The evaluation of surgical competency and the assessment of the education and continued competency of practicing surgeons will be more crucial than before. We have learned technical skills through several methods until now. However, procedural training has been unsystematic and unstructured, and proper teaching methods have not been established. Surgical skill training, for instance, has been performed using live patients and animals, human cadavers, and ex vivo animal tissue until now. With regard to these materials, there were several limitations due to ethical problems, the inexact replication of human anatomy, and the reality and expense for animals. In the past, performing on live patients and animals had been considered the best method for learning basic skills. Animal hearts from porcines and bovines, for instance, were useful tools given their similarities in size and anatomy to the human heart, as well as their beating operations. However, recently the methods used on live patients and animals are no longer viable due to the increasing complexity of cases, costs, and ethics. Human cadavers have proven the best alternative for studying the human anatomy, yet it is not prevalent here in Japan. Instead, ex vivo animal tissues have been used to teach basic technical skills for residents. During the last decade, operative methods have undergone significant changes compared to the classic styles, which are relatively invasive open surgery. Minimal invasive surgeries, however, have evolved in both thoracic and cardiovascular disease such as therapeutic bronchoscopy, endoscopic lung resection, robotic approaches to esophageal resection, off pump coronary artery bypass grafting, endovascular stent grafting to aortic disease, hybrid approaches to congenital heart disease, and endovascular repair to valvular heart disease. In such situations, it is important to evaluate the technical skills and surgical competency for the patient’s safety [1]. The simulation system is now spotlighted for learning both technical skills, situational simulation, and for evaluating competency performance and surgical skills objectively. Simulation training was found to improve subsequent performances compared with subjects cake received didactic training alone. This benefit was found to be durable and persistent in the long term. This presidential address was written at the invitation of the editorial committee.

History of cardiovascular surgery and its future: A personal review

Five decades have passed since I obtained my doctorate of medicine. Soon after graduation I had the chance to become a resident in the regional hospital of Locarno in southern Switzerland and to begin my favorite surgical experience. One night in October 1946 the professor of surgery of the University of Berne, Karl Lenggenhager, was brought to our clinic heavily wounded and unconscious after a mountain accident. The name of Professor Lenggenhager was known to me from the literature as the initiator in the 1930s of the miniheparin prophylactic treatment, a method to prevent postoperative thrombosis and embolism, which I had already introduced in our surgical department in 1945. I was convinced that the eminent, unconscious patient would like to benefit from the same prevention as his own patients in the University Clinic of Berne. The next day, when I made the third intravenous injection of heparin to the now conscious patient, he was surprised and happy to know that his own method of protection had been routinely used for surgical patients in our small district hospital since 1945. Upon my next visit a few hours later, my famous patient made me the offer to become a resident in his own clinic, which I thankfully and enthusiastically accepted. For four decades, I remained at the University Clinic of Berne. It was the same Professor Lenggenhager who, in 1953, helped me to get a fellowship for cardiovascular surgery from the American Swiss Foundation for Scientific Exchange. Our common goal was to obtain a modern and up-to-date cardiovascular unit in Berne. After the first successful closure of a patent duct by Dr. Robert Gross in 1938, astonishing developments in heart and vascular surgery had taken place between 1944 and 1952. In 1944, the same Dr. Robert Gross, in Boston, and Dr. Clarence Crafoord, in Sweden, initiated the