Single-Center Experience of Pulmonary Endarterectomy for Chronic Thromboembolic Pulmonary Hypertension: The Results from the Tabriz University Medical Sciences (TUMS) CTEPH Program.

INTRODUCTION: Pulmonary endarterectomy (PEA) remains the preferred and potentially curative option for patients with chronic thromboembolic pulmonary hypertension (CTEPH). This study aimed to report the results of PEA for CTEPH in a tertiary center in Tabriz, Iran. METHODS: We analyzed the results of 42 CTEPH patients undergoing PEA, who were enrolled in the Tabriz University of Medical Sciences (TUMS-CTEPH) from January 2016 to October 2020. The main outcome measures included the New York Heart Association (NYHA) functional classification, the 6-Minute Walk Distance, hemodynamic measures in right heart catheterization, morbidity, and mortality. RESULTS: There was a significant improvement in the NYHA function class (2.6 ± 0.5 vs 1.1 ± 0.34), mean pulmonary arterial pressure (47.1 ± 13 vs 27.9 ± 8 mm Hg), cardiac output (4.3 ± 1.06 vs 5.9 ± 1.2 L/min), and pulmonary vascular resistance (709.4 ± 297.5 vs 214 ± 77 dyn s/cm5). Fifteen patients (35%) developed complications. The most common complication (10 [23%]) was reperfusion injury. Also, postsurgical mortality was 4% during hospital admission and 1-year follow-up. CONCLUSION: This is the first single-center report of PEA from Iran. Post-PEA and 1-year survival were acceptable as a referral center. PEA can be performed safe with low mortality. Greater awareness of PEA and patients' access to experienced CTEPH centers are important issues.

Do nondiabetic patients undergoing coronary artery bypass grafting surgery require intraoperative management of hyperglycemia?

OBJECTIVE: To study the effect of blood glucose (BG) control with insulin in preventing hyperglycemia during and after coronary artery bypass grafting (CABG) surgery in nondiabetic patients. METHODS: In a randomized clinical trial, 120 nondiabetic patients who underwent elective CABG surgery were enrolled for study of whether the control of hyperglycemia was a need in such a surgery in a teaching heart hospital. The patients were randomly divided into study (n=60) and control (n=60) groups. In the study group, insulin was infused to maintain BG level between 110 mg/dL and 126 mg/dL (a modified insulin therapy protocol, and in the control group, the patients were excepted). Insulin therapy was limited to intraoperative period. BG levels during surgery and up to 48 hours after surgery and early postoperative complications were compared between the study and control groups. RESULTS: One hundred seventeen patients completed the study (59 patients in study group and 58 in control group). Peak intraoperative BG level in the study group was 126.4±17.9 mg/dL and in the control group was 137.3±17.6 mg/dL (p=0.024). The frequencies of severe hyperglycemia (BG≥180 mg/dL) were 6 of 59 (10.1%) in the study group and 19 of 58 (32.7%) in the control group during operation (p=0.002). Peak postoperative BG level in the study group was 194.8±41.2 mg/dL and was 199.8±43.2 mg/dL in the control group (p=0.571). There was no hypoglycemic event in either group. The frequencies of early postoperative complications were 10 of 59 (16.9%) in the study group and 19 of 58 (32.7%) in the control group (p=0.047). CONCLUSIONS: Hyperglycemia (BG≥126 mg/dL) is common in nondiabetic patients undergoing CABG surgery. A modified insulin therapy to maintain BG level between 110 mg/dL and 126 mg/dL may be acceptable for avoiding hypoglycemia and keeping intraoperative BG levels in acceptable range in nondiabetics.

Anesthesia with etomidate and remifentanil for cesarean section in a patient with severe peripartum cardiomyopathy--a case report.

Patients with peripartum cardiomyopathy may require analgesia/anesthesia for delivery or cesarean section. Many different methods of anesthesia has been used for this purpose. Remifentanil was used safely in peripartum cardiomyopathic patients, but there is not any report about etomidate usage in such patients. We report on a 19 years old patient, at 32 weeks of gestation, with severe peripartum cardiomyopathy, in uncompensated heart failure and pulmonary edema. She was scheduled for emergency cesarean section becaue of threatening mother's life and fetal distress. General anesthesia was induced with etomidate and maintained with remifentanil infusion safely, without any adverse outcome on mother or newborn.

Preoperative transcranial and carotid Doppler study in coronary artery bypass graft patients.

OBJECTIVE: To assess the correlation of postoperative neurologic complications with preoperative transcranial and carotid Doppler study findings of coronary artery bypass graft (CABG) patients. METHODS: In a descriptive, analytic, follow up study we prospectively studied 201 patients undergoing elective and isolated CABG surgery during a 12 month period from October 2003 to September 2004 at Madani Hospital of Tabriz Medical Sciences University, Iran. Neurologic examination, intracranial cerebral arterial study using transcranial Doppler (TCD) and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up for one month. RESULTS: Two hundred and one patients (158 male, 43 female) with a mean age of 57.29+/-9.67 were studied. Out of these, 131 patients had 3 coronary vessels disease, 64 had 2 vessels, 5 had one vessel, and one patient had diffuse coronary disease. A TCD was performed in 183 patients and disclosed abnormalities in 22 patients and was normal in 161 cases. The total number of involved arteries was 34. Among 154 carotid duplex studied patients, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in one, and 75-90% stenosis in 2 cases. Postoperative neurologic complication occurred as follows: 4 stroke, 7 delirium, and 3 amnesia. One of the operated patients died. Nine of 161 patients with normal TCD (5.6%) and 5 of 22 (22.7%) with intracranial cerebral arterial disease (ICAD) showed central nervous system (CNS) complications (p=0.015). There were significant correlations between number of involved cerebral arteries and post CABG CNS complications (p=0.0001), including stroke (p=0.007), and between diabetes mellitus history with these complications (p=0.012). CONCLUSION: Our results suggest that lCAD is an independent risk factor for CNS complications after CABG surgery. Hence, we recommend pre-CABG evaluation of the cerebral arteries by TCD, for the risk assessment of CABG surgery.