Risk factors in the development of postoperative complications after reconstructive surgery on the thoracic aorta.

Aim To determine risk factors responsible for developing postoperative complications after the thoracic aorta reconstructive surgery. Methods Medical records of 100 patients, who had undergone elective or emergency thoracic aorta reconstructive surgery at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, were analysed. Intraoperative data as cross-clamp time (CCT), duration of cardiopulmonary bypass (CPBT) and hypothermic circulatory arrest time (HCAT) were evaluated. Univariate analysis was used to show risk factors for developing postoperative cardiac, respiratory, surgical and renal complications. Results Between May 2019 and April 2021, 48 Bentall procedures (BP), 23 ascending aortic replacements (AAR), 20 BP and coronary artery bypass grafting (CABG) and 9 aortic valve replacements (AVR) with AAR were performed. Incidence of postoperative complications in the elective and emergency groups was as follows: respiratory 20% vs 38% (p=0.049), cardiac 18% vs 70% (p=0.015), renal 16% vs 48% (p=0.027) and surgical 4% vs 6% (p>0.05). Intrahospital 30 days morbidity was 44% with mortality rate of 13%. The results showed that CPBT>180 minutes was a risk factor for respiratory (p=0.034), cardiac (p=0.020) and renal (p=0.027) postoperative complications after acute type A aortic dissection surgery. Conclusion CPBT > 180 min is a risk factor for postoperative development of respiratory, cardiac and renal complications. Postoperative cardiac and renal complications were associated with longer HCAT.

Percutaneous Transluminal Angioplasty of Subclavian Artery Lesions.

INTRODUCTION: Percutaneous transluminal angioplasty (PTA) is one of the treatment options for stenotic and obstructive lesions of the subclavian artery. AIM: To evaluate initial and long-term results of percutaneous transluminal angioplasty of subclavian artery lesions. METHODS: During period February 2016 to December 2017, 26 patients (12 men and 14 women) with significant subclavian artery stenosis and occlusion were admitted and underwent PTA. All patients were symptomatic. All PTA procedures were performed with the patient under local anesthesia, through the femoral artery (n=22), brachial artery (n=4), or combined route (n=6). In 7 patients, we performed direct stenting, while in the other 15 patients we performed predilatation before stent implantation. The follow-up protocol consisted of regular clinical examinations in 1, 3, 6 and 12 months post-procedural, and annually thereafter with duplex ultrasound monitoring. RESULTS: Initial technical success was achieved in 22 of 26 procedures (84.61%), 100% in stenotic lesions and 55.5 % in total occlusions. Fourth of nine occlusions could not be recanalized by PTA. These patients were managed surgically. The 30-day mortality rate was 0% for the entire group. No patients required reintervention for recurrence of symptoms and the stents remain patent at period of 12 months post-procedural. CONCLUSION: The minimal invasive technique, the markedly lower complication rate, the high long-term patency, patient's comfort and the decreased hospital stay have made endovascular repair the primary choice of treatment in the majority of cases, especially in patients with stenotic lesions and high-risk patients. We consider PTA of subclavian artery stenotic/obstructive lesions should be the first therapeutic option.

New-onset atrial fibrillation after percutaneous coronary intervention or coronary artery bypass grafting for left main disease.

Aim To determine the prevalence of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and its effect on 6-month cardiovascular outcomes. Methods This prospective study included 40 patients diagnosed with LMCAD, in the period from 2017 to 2018. The patients with LMCAD and low or intermediate SYNTAX score were randomized to PCI with zotarolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. Results Among 40 patients without atrial fibrillation on presentation, NOAF developed 3.1±1.3 days during hospitalization in three CABG treated patients, and one PCI treated patient. One patient that was CABG treated developed NOAF after two months. Patients with versus patients without NOAF had a significantly longer duration of hospitalization, probably because they were discharged on anticoagulant therapy. Myocardial infarction was presented in one CABG treated patient after 3 months, and also in one PCI treated patient after 4 months. One patient died 2 months after the operation, and one developed stroke 5 months after the CABG operation. Conclusion The NOAF was common after CABG, but extremely rare after PCI, and it occurred almost exclusively following CABG. There was a clear statistical tendency for all-cause death, cardiovascular death and stroke at 6-month follow-up period.

Posterior reversible encephalopathy syndrome (PRES) as a complication of immunosuppressive therapy in renal transplantation in children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.

Posterior Reversible Encephalopathy Syndrome (PRES) as a Complication of Immunosuppressive Therapy in Renal Transplantation in Children.

Although kidney transplantation is by far the best method of renal replacement therapy, organ receiver is still not spared of eventual toxic consequences of drugs that are in charge of keeping the transplanted kidney functional. Both calcineurin inhibitors, of which tacrolimus more often, occasionally lead to neurotoxic side effects, mostly mild and reversible and dose-dependent in nature, but they can also be very severe or even fatal. It is very important to be aware of possible neurotoxic effects, to confirm them radiologically, and to prevent or reduce drug effects on nervous system. Sometimes the reduction of dose or substitution with another drug with similar mechanism effect is sufficient to terminate the neurotoxic effects of the drug and still not jeopardize the function of transplanted organ.