Surgery-related complications in cardiac transplantation patients.

OBJECTIVE: The surgical techniques was first described by Lower and Shumway for cardiac transplantation have not changed for many years; they are still being commonly used worldwide despite recently presented alternatives. We sought to evaluate the surgical complications among our cardiac transplantation patients in whom we performed the standard technique. PATIENTS AND METHODS: The standard biatrial anastomosis technique was used in 13 patients who have a mean follow-up of 18.6 (1 to 38) months. During the follow-up, echocardiographic assessment was performed to evaluate left and right atrial diameters, tricuspid and mitral valve regurgitation, interatrial septum, and suture lines. Elecotrocardiograms were evaluated for arryhthmia and pacemaker requirements in the midterm. RESULTS: The mean left and right atrial diameters were measured as 40.5 (32 to 57) x 66.6 (48 to 78) and 37.9 (32 to 43) x 56.3 (48 to 69) mm, respectively. The jet area was calculated at less than 5 cm(2) for mitral and tricuspid valve regurgitation, which can be defined as "mild" regurgitation. There was no increase in the degree of regurgitation of both atrioventricular valves during the follow-up period. In one patient, a thrombus was detected in the suture line; there was a nonsignificant left to right shunt in another patient. A temporary pacemaker was indicated in two patients. Atrial fibrillation was detected in three patients, who responded to medical therapy. During the follow-up atrial fibrillation developed in one patient. CONCLUSION: The cardiac transplantation operation using the standard technique may result in atrial dysfuntion due to deformation of atrial integrity and geometry. However, when we evaluated our results, we concluded that the standard surgical technique was a safe, simple, effective, and feasible method.

Thrombosis in Continuous Flow Left Ventricular Assist Devices: Our Clinical Experience With Medical and Surgical Management.

BACKGROUND: Continuous-flow left ventricular assist devices (CF-LVADs) such as the HeartMate II and HeartWare left ventricular assist device are important alternatives to heart transplantation. Thrombosis is a serious complication in both devices and we present our approach to treating thrombosis and analysis of predisposition factors. METHODS: Our center's CF-LVADs database was retrospectively reviewed for pump thrombosis between January 2011 and January 2015. The patients were grouped for pump thrombosis (n = 13) and nonpump thrombosis (n = 85). Patients with pump thrombosis were further divided by device type (n = 5 HeartMate II and n = 8 HeartWare left ventricular assist device). Predisposition factors for pump thrombosis, our treatment approach, and patient outcomes were evaluated. RESULTS: Pump thrombosis was diagnosed in 13 of 98 patients. The rate of pump thrombosis did not differ between the 37 HeartMate II and 61 HeartWare left ventricular assist device patients. High mean arterial blood pressure (P < .01) and noncompliance with the anticoagulation regimen (P = .04) were associated significantly with thrombosis. Twelve patients with stable hemodynamics were treated initially with intravenous tissue plasminogen activator and 1 patient who had end-organ damage underwent pump exchange. Two patients failed to respond to medical treatment and underwent pump exchange. Two patients with recurrent thrombosis were administered intracardiac tissue plasminogen activator. Five patients died after medical treatment and 4 deaths were due to cerebral hemorrhage. CONCLUSIONS: Avoiding increased mean arterial blood pressures and ensuring optimal anticoagulation may help to decrease pump thrombosis. In patients with pump thrombosis, thrombolytic therapy is an alternative that is less invasive than pump exchange, but carries the risk of hemorrhage and thromboembolism.

Dysnatremia on intensive care unit admission is a stronger risk factor when associated with organ dysfunction.

AIM: Dysnatremia present at the time of intensive care unit (ICU) admission is associated with mortality. In this study, we investigated the epidemiology of dysnatremia present on ICU admission and the impact of organ dysfunction on the association between dysnatremia and mortality. We hypothesized that dysnatremia comorbid with organ dysfunction is associated with higher risk of mortality. METHODS: This retrospective study was conducted on all patients admitted to the International Hospital General ICU in Istanbul over a period of 6 years (2006-2011). Patients were classified, according to the most abnormal serum sodium values measured within 24 hours after ICU admission, into 7 groups as follows: normonatremia (135≤Na≤145 mmol/L), borderline hyponatremia (130≤Na<135 mmol/L), mild hyponatremia (125≤Na<130 mmol/L), severe hyponatremia (Na <125 mmol/L), borderline hypernatremia (145155 mmol/L). RESULTS: The total admitting patient were 1657. A total of 1060 patients' data were analyzed in this study. Sodium levels were normal in 637 (60.1%), hyponatremic in 367 (34.6%) and hypernatremic in 56 (5.3%) patients. Multivariate analysis showed that only SAPS II was associated with increased mortality (OR, 1.05 [95% confidence interval, 1.02-1.09]). The odds ratio (95% CI) of dysnatremia (Na <125 mmol/L and >150 mmol/L) for mortality was 4.37 (2.29-8.36) in patients with organ dysfunction (number of dysfunctional organs ≥1) (P<0.001). CONCLUSION: Below 125 and above 150 mmol/L sodium levels at ICU admission are risk factors for higher mortality rates in patients with comorbid organ dysfunction. The effect of dysnatremia on mortality is observed when organ dysfunction is present.