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Electrical failure during cardiopulmonary bypass is a crisis situation for the cardiac surgical team. Fortunately, it has a low incidence with low morbidity and mortality rates. Notwithstanding, institutional preventative and management measures should be taken. Here, we report a case of electrical failure during cardiopulmonary bypass, which was successfully managed during the surgery, allowing the patient to recover uneventfully. These unwanted complications can only be managed by promoting awareness and putting in place strategies against them.
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Global myocardial ischemia and ischemia-reperfusion injury are potential adverse events related with cardioplegic arrest. Beating heart surgery has avoided such complications and adapted to valve surgery following successful results published on myocardial revascularization. Difficulty in weaning from cardiopulmonary bypass may be lessened by using on-pump beating heart surgery for mitral valve interventions. Here we describe a 64-year-old male patient with severe mitral regurgitation and dilated cardiomyopathy. Beating heart mitral valve replacement surgery was performed without aortic cross-clamping through a right thoracotomy approach. We believe that, particularly in patients with poor left ventricular functions, beating heart mitral valve surgery may be advantageous.
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OBJECTIVE: Even with the improvements in surgical techniques and perioperative care, obesity is still a risk factor for occurrence of adverse events following cardiac surgery. In this observational, retrospective study, we aimed to document the effects of obesity on surgical outcomes in patients undergoing coronary artery bypass surgery and find out the effects of improvements in cardiac surgery. METHODS: Between January 2011 and March 2013, isolated coronary artery bypass surgery was performed on 790 patients. The body mass index values of the patients were calculated and patients were divided into two groups; below 30 were classified as non-obese group whereas above 30 were classified as obese group. The odds ratio was obtained by using univariate analysis in order to document the effects of obesity on outcomes. RESULTS: There were 548 (69.3%) patients in non-obese group, whereas 242 (30.7%) patients in obese group. The cardiopulmonary bypass (80.47±23.58 vs. 80.89±28.46, p=0.449) and aortic clamp times (54.13±16.60 vs. 54.19±19.85, p=0.511) and number of bypass grafts (3.09±1.02 vs. 2.96±1.00, p=0.11) were comparable between the groups. The mean number of fresh frozen plasma used was higher in obese patients (1.37±1.75 vs. 1.48±4.63, p=0.02). Intubation time was higher in obese patients (10.57±6.87 vs. 12.71±35.31, p=0.014). Total amount of postoperative drainage was higher in non-obese patients (766.77±472.27 vs. 648.72±371.39, p<0.001). The superficial infection/mediastenitis (0.4% vs. 2.5%, p=0.012), dehiscence (0.2% vs. 3.7%, p<0.001) and postoperative renal failure rates (4.7% vs. 8.7%, p=0.031) were higher in obese patients. The incidence of atrial fibrillation was lower in obese patients (19.7% vs. 12.8%, p=0.019). The mortality (0.5% vs. 1.7%, p=0.210) and postoperative stroke rates (1.1% vs. 0.8%, p=1.000) were similar in both groups. CONCLUSION: We documented that obesity is still a risk factor for occurrence of postoperative adverse events. We believe that improved perioperative care together with meticulous regimens can improve postoperative outcomes in patients undergoing coronary artery bypass surgery.
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Puente de Arteria Coronaria , Infarto del Miocardio/cirugía , Obesidad Mórbida , Índice de Masa Corporal , Gasto Cardíaco Bajo/epidemiología , Gasto Cardíaco Bajo/etiología , Humanos , Infarto del Miocardio/mortalidad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Insuficiencia Renal/epidemiología , Insuficiencia Renal/etiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Atrioventricular groove rupture is a rare, albeit mortal, complication following mitral valve surgery. Avoidance is the best strategy but it cannot fully prevent the occurrence of this complication. Several repair techniques have been described with varying success rates; however, the rarity of the complication precludes consensus about the safest technique. Here we report two cases of posterior atrioventricular groove rupture. Both cases were diagnosed immediately after the cessation of cardiopulmonary bypass. Repair was performed successfully with a technique involving the use of biological glue. The postoperative course was uneventful for both of them. Both cases are well with normally functioning mitral prostheses; one with a follow-up time of 5.5 years and the other 10 months. We believe that the glue provides additional hemostasis and support to the repaired area.
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Heparin is a universal drug used frequently for its anticoagulant effects. The variabilities in distribution and tendency of heparin to accumulate in tissues cause increased tissue concentrations despite normal serum levels. We aimed to underline the toxic effects of heparin in cell culture make projections for clinical applications. L929 mouse fibroblastic cell line was plated in 96-well culture plates at an initial density of 5000 cells/well. Heparin was prepared in 10 different concentrations (10-300 units/well). Following 3 days of incubation, viabilities were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay for each concentration in each day and compared. The viability of cells decreased significantly with increasing doses of heparin; at least 50 units/well in the first and second days and at least 20 units/well in the third day (P < 0.05 for each). There was statistically significant difference when the viabilities of cells treated with same heparin concentration in different days were compared (P < 0.05). The authors clearly demonstrated the toxic effects of heparin in cell culture, toxic effects increased as the dose increased. To prevent the unwanted clinical side-effects of heparin further studies should be made and more accurate testing methods should be developed to determine the effective tissue concentration of heparin.
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Anticoagulantes/toxicidad , Fibroblastos/efectos de los fármacos , Heparina/toxicidad , Animales , Técnicas de Cultivo de Célula , Fibroblastos/citología , RatonesRESUMEN
BACKGROUND: The efficacy of epidural anesthesia and analgesia in management of perioperative stress has been established. Perioperative pain management strategies decrease surgical complications and aid recovery. In this study, we aimed to document and compare the efficacy of epidural bupivacaine and intravenous meperidine on recovery of patients with elective abdominal aortic surgery performed under general anesthesia. MATERIAL AND METHODS: Patients undergoing elective abdominal aortic surgery between February 2009 and November 2011 were studied prospectively. Patients were randomized into epidural bupivacaine (n=40) and intravenous meperidine (n=40) groups regarding postoperative analgesia strategy. The preoperative demographic characteristics, perioperative outcomes, postoperative adverse effects of analgesia strategy, time to initiate oral intake, sedation scores, visual analogue scale results, and mobility scores were compared. RESULTS: The mean ages of the patients were 61.7±8.1 in the epidural group and 59.4±9.7 in the intravenous group (p>0.05). The preoperative demographic characteristics of the patients were comparable between the groups. There were no statistically significant differences between groups regarding anesthesia times, intubation times, intensive care unit stay, hospital length of stay, postoperative vomiting, and postoperative cardiac, renal, and cerebral complications. Postoperative nausea was more prevalent in the meperidine group (p<0.05). In the epidural group, time to begin oral intake was shorter, sedation scores and visual analogue scale results were lower, and mobility scores were higher (p<0.05 each). CONCLUSIONS: Epidural analgesia allowed earlier recovery compared to intravenous analgesia in patients undergoing elective abdominal aortic surgery, but did not affect postoperative outcomes and complications.
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Analgesia Epidural , Aorta Abdominal/cirugía , Bupivacaína/farmacología , Procedimientos Quirúrgicos Electivos , Meperidina/farmacología , Recuperación de la Función/efectos de los fármacos , Bupivacaína/administración & dosificación , Demografía , Femenino , Humanos , Inyecciones Intravenosas , Masculino , Meperidina/administración & dosificación , Persona de Mediana Edad , Atención Perioperativa , Resultado del TratamientoRESUMEN
BACKGROUND: Since the advent of cardiopulmonary bypass, many efforts have been made to avoid the complications related with it. Any component of the pump participates in occurrence of these adverse events, one of which is the type of prime solution. In this study, we aimed to compare the effects of 6% hydroxyethyl starch 130/0.4 with a commonly used balanced electrolyte solution on postoperative outcomes following coronary bypass surgery. METHODS: Two hundred patients undergoing elective coronary bypass surgery were prospectively studied. The patients were randomized in to two groups. First group received a balanced electrolyte solution and the second group received 6% hydoxyethyl starch 130/0.4 as prime solution. The postoperative outcomes of the patients were studied. RESULTS: The mean age of the patients was 61.81 ± 10.12 in the crystalloid group whereas 61.52 ± 9.29 in the HES group. There were 77 male patients in crystalloid group and 74 in HES group. 6% hydroxyethyl starch 130/0.4 did not have any detrimental effects on renal and pulmonary functions. The intensive care unit stay and postoperative hospital length of stay were shorter in hydroxyethyl starch group (p < 0.05 for each). Hydroxyethyl starch did not increase postoperative blood loss, amount of blood and fresh frozen plasma used, but it decreased platelet concentrate requirement. It did not have any effect on occurrence of post-coronary bypass atrial fibrillation (p > 0.05). CONCLUSIONS: 6% hydroxyethyl starch 130/0.4 when used as a prime solution did not adversely affect postoperative outcomes including renal functions and postoperative blood transfusion following coronary bypass surgery.
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Puente Cardiopulmonar/métodos , Derivados de Hidroxietil Almidón/uso terapéutico , Soluciones Isotónicas/uso terapéutico , Sustitutos del Plasma/uso terapéutico , Anciano , Fibrilación Atrial , Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Puente de Arteria Coronaria/métodos , Soluciones Cristaloides , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: Sternal dehiscence is a severe complication of open heart surgery. Reinforced wiring, a system of reinforced sternal closure, fixation of a rigid plate, and implantation of thermoreactive nitinol clips (TRC) are some surgical procedures used. The aim of this study was to evaluate the role of TRC for secondary sternal reconstruction. METHODS: Of 1198 patients who underwent their operations via median sternotomy in 2 separate medical centers, sternal dehiscence was observed in 16 patients overall (1.33%). The mean (SD) age of the patients was 64.06 ± 9.18 years (range, 40-77 years). Sternal dehiscence was diagnosed in all patients between the fifth and 30th postoperative days. RESULTS: TRC were implanted in all of the patients who developed sternal dehiscence (16 patients). One patient developed severe respiratory failure, became ventilator dependent, and died from pneumonia on postoperative day 24. The other 15 patients were discharged without complications. Postoperative follow-up of the surviving patients revealed adequate and satisfactory sternal stability. CONCLUSION: Implantation of TRC is an effective and easy method for fixing the sternum and can be performed rapidly and securely.
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Aleaciones , Procedimientos de Cirugía Plástica/instrumentación , Esternotomía/efectos adversos , Instrumentos Quirúrgicos , Dehiscencia de la Herida Operatoria/cirugía , Adulto , Anciano , Procedimientos Quirúrgicos Cardíacos/efectos adversos , Procedimientos Quirúrgicos Cardíacos/métodos , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Reoperación/métodos , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Esternotomía/métodos , Dehiscencia de la Herida Operatoria/diagnóstico , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND: Atrial Fibrillation is the most common arrhythmia encountered following cardiac surgery. The most commonly administered drug used in treatment and prophylaxis is amiodarone which has several toxic effects on major organ functions. There are few clinical data concerning prevention of toxic effects and there is no routinely suggested agent. The aim of this study is to document the cytotoxic effects of amiodarone on cell culture media and compare the cytoprotective effects of commonly used antioxidant agents. METHODS: L929 mouse fibroblast cell line was cultured and 100,000 cells/well-plate were obtained. First group of cells were treated with increasing concentrations of amiodarone (20 to 180 µM) alone. Second and third group of cells were incubated with one-fold equimolar dose of vitamin C and N-acetyl cysteine prior to amiodarone exposure. The viability of cells were measured by MTT assay and the cytoprotective effect of each agent was compared. RESULTS: The cytotoxicity of amiodarone was significant with concentrations of 100 µM and more. The viabilities of both vitamin C and N-acetyl cysteine treated cells were higher compared to untreated cells. CONCLUSIONS: Vitamin C and N-acetyl cysteine are commonly used in the clinical setting for different purposes in context of their known antioxidant actions. Their role in prevention of amiodarone induced cytotoxicity is not fully documented. The study fully demonstrates the cytoprotective role of both agents in amiodarone induced cytotoxicity on cell culture media; more pronounced with vitamin C in some concentrations. The findings may be projectile for further clinical studies.
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Amiodarona/toxicidad , Antioxidantes/farmacología , Acetilcisteína/farmacología , Animales , Ácido Ascórbico/farmacología , Línea Celular Transformada , Supervivencia Celular/efectos de los fármacos , Interacciones Farmacológicas , Fibroblastos/citología , Fibroblastos/efectos de los fármacos , Ratones , Estrés Oxidativo/efectos de los fármacosAsunto(s)
Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Vasos Coronarios/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/patología , Vasos Coronarios/patología , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A secundum atrial septal defect is the most common congenital heart defect. Transcatheter treatment of secundum atrial septal defects is a popular and less invasive alternative to surgery. Procedural complications may occur in a wide spectrum, particularly device embolus as the most emergent one, but luckily they do not commonly occur in the clinical setting. Mortality from adverse events related to transcatheter treatment strategies is twentyfold higher than that of primary elective surgical closure. Here, we report an Amplatzer device embolus in a secundum atrial septal defect patient. The device was successfully removed with surgery, postoperative course was uneventful, and the patient was discharged from the hospital on the 5(th) postoperative day.
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Spontaneous, isolated focal renal artery dissection is an extremely rare cause of renovascular hypertension. Imaging technology for the renal arteries has evolved recently with the development of multidetector computed tomography angiography (CTA), and intravascular ultrasound. We describe a 52-year-old man with spontaneous renal artery dissection complicated by renovascular hypertension, successfully diagnosed initially with CTA, then evaluated by intravascular ultrasound, and finally, treated successfully with stenting.