report on emergent pulmonary embolectomy

Introduction: Pulmonary embolism is one of the leading causes of mortality in patients. The mortality rate of this disease can be significantly reduced with appropriate treatment. Surgical intervention can be highly effective for the treatment of acute massive pulmonary embolism. This article presents a report on the experience of acute pulmonary embolectomy

Materials and Methods: Demographic data, rate of mortality, as well as surgical and post-operative complications were recorded and analyzed

Results: In general, 12 patients with mean age of 60 +/- 13.39 year were included in the study. None of the patients had significant arrhythmia during the surgery, but 25% suffered from post-operative arrhythmia. Moreover, electrical cardioversion was administered to 8% of the patients, 8% received pharmaceutical interventions, and the rest of the patients sustaining arrhythmia [9%] survived with specific metabolic correction. The diagnosis of acute pulmonary embolism was correct in 100% of the patients, with 33.3% of the cases suffering from this disease due to recent surgeries. In 41.6% of the patients, blood clots were observed in the pulmonary artery, right atrium, and right ventricle. The three-month follow-up of the patients showed that 83.3% of the cases were alive. There were two cases of mortality, one of which occurred at the end of surgical procedure and the other one happened in the intensive care unit. The results of independent t-test did not indicate any significant relation between mortality and ejection fraction of the patients [P=0.189]. Moreover, there were not any significant differences between the patients' pre-and post-operative laboratory tests [P?0.05]. Nonetheless, hemoglobin and hematocrit levels were significantly different pre-and post-operation [P=0.0001]

Conclusion: Our data suggest that acute pulmonary embolism can be treated successfully with favorable outcome and a mortality rate of approximately 16.6%, if evaluation and diagnosis are done as soon as possible in patients who require surgical intervention

Problems of cold agglutinins in cardiac surgery: how to manage cardiopulmonary bypass and myocardial protection

Cold agglutinins are of unique relevance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass [CPB]. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins [usually IgM or IgA antibodies] that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease. Immunoglobulin M autoantibodies to red blood cells, which activate at varying levels of hypothermia, can cause catastrophic hemagglutination, microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB and myocardial protection requires individualized planning. We describe a case of MV repair and CABG in a patient with high titer cold agglutinins and high thermal amplitude for antibody activation. Normothermic CPB and continuous warm blood cardioplegia were successfully used

Comparison of unstable hemodynamic patients undergoing coronary artery bypass graft surgery with on- or off-pump methods

Introduction: Coronary artery disease [CAD] is the most common type of heart disease, with a mortality rate of 385,000 person per year in the United States. There are two main methods for CAD treatments: angioplasty and bypass surgery. Coronary Artery Bypass Grafting [CABG] is one of the greatest surgical operations of the 20th century and it is presented as most effective and long-term therapies in the treatment of ischemic heart disease. There are two different methods of CABG; on-pump and off-pump. While off-pump CABG is a newer method, it decreases stroke and maintains higher mental function. We conducted the assessment of patients' outcome that underwent on- or off-pump CAGB with hemodynamic instability

Materials and Methods: In this cross-sectional study, we evaluated cardiogenic shock patients with CABG who referred to Ghaem hospital for emergency operation from January 2012 to November 2013. We collected medical records archive from this hospital and all patients' information including demographic data, clinical variables, and past medical history separately. We performed on and off-pump CABG surgery for the patients. In on pump group, we performed beating on pump method, without aortic cross clamping

Results: Twenty-eight patients who underwent CABG in two forms: on-pump and off-pump were studied. The minimal age of the patients was 34 and the maximal was 78. Patients' weight had a range between 60 to 95 kg. The minimum used graft were two and the maximum were five. Ejection fraction was diversified between 15% [min] and 50% [max]. Operation time ranged 1.50 to 5.50 hours. The ICU stay time was between 2[min] to 11 [max] days. Finally death was occurred in 5[17.9%] of patients

Conclusion: Our findings showed that CABG with beating heart could increase the survival of hemodynamic unstable patients in comparison with off-pump CABG

evaluation of survival in patients who need intra aortic balloon pump [IABP] after cardiac surgery

Introduction: In some cases, assist devices are required to ensure an adequate cardiac output after cardiac surgery. Intra-aortic balloon pump [IABP] is the most commonly used cardiac assist device, which provides first-line support for patients with heart failure. The aim of this study was to determine factors affecting the mortality rate of patients receiving IABP

Materials and Methods: In this retrospective cohort study, 235 patients requiring IABP support were analyzed over 14 years period [between January 1999 and December 2013] from which 137 patients survived the 30 days follow-up. Perioperative and demographic factors such as age, weight, underlying disease, ejection fraction, ventricular aneurysm and cardiopulmonary bypass [CPB] and cross clamp time were recorded and analyzed

Results: The overall operative mortality was reported to be 41.7%. Male-to-female ratio was 131:104 and the mean age of the subjects was 57.58 +/- 11.07 years. Early mortality rate was higher among young subjects and those with prolonged CPB [162.71 +/- 35.25, P<0.001] and ACC [129.94 +/- 54.39, P<0.001]. In addition, mortality rate was higher among females [P=0.04]. Patients' weight, comorbidity, preoperative ejection fraction, ventricular aneurysm and stenosis of the left main coronary did not affect the mortality rate [P>0.05]

Conclusion: IABP is a simple, effective method for temporary cardiac support, especially for aged patients. In addition, lower duration of surgery is associated with better surgical outcomes

Emergency conversion from off pump to cardiopulmonary bypass in patients with coronary artery bypass graft surgery

As off pump Coronary artery bypass grafting surgery [CABG] is a developing method in coronary cardiac surgery, most surgeons are anxious about the danger of emergency crash conversion. In this observational study we tried to show the rate and outcome of conversion In this descriptive study about 477 coronary offpump CABG patients were operated in Ghaem hospital in Mashhad, Iran, from Jan 2012 to Jan 2013. In this group 20 patients needed to convert to Cardiopulmonary Bypass [CPB] immediately. We analyzed these 20 patients and produced the results. There was no cerebrovascular accident [CVA] and no neurologic problems. There was one death among these 20 patients. There was one case of renal failure who was the same patient that expired.75% of these 20 patients had hypertension and 45% had diabetes.20 patients [4.19%] had an emergency switch to On-pump CABG and only one death occurred among 20 patients