Outcome predictors in lung transplant patients

Lung transplantation has become an established treatment for selected patients with end stage pulmonary disease. The Alveolar-arterial [A-a] gradient shown to be useful marker of post-operative pulmonary morbidity in patients undergoing single lung transplantation. The purpose of this study was to determine the utility of the [A-a] gradient in predicting post-operative morbidity and mortality in patients undergoing single as well as double lung transplantation. A retrospective study was done in a single institution where 25 patient underwent lung transplantation, [A-a] gradients were calculated for each patient pre-operative, post-operative and a variable post-operative minus pre-operative, linear regression was performed to assess the relationship between each A-a gradient variable and overall morbidity [including infection, neurological, respiratory and renal complications] as well as mortality. Using the [A-a] gradient measurement peri-operatively we found that there was a significant relation to overall morbidity. Patients with a 50 point higher [A-a] gradient change post-operatively from pre-operative value would be 1.8 times more likely to have morbidity. This study shows that using the pre-operative and post-operative [A-a] gradient can be useful and easy tool to predict post-operative morbidity

Open heart surgery after mediastinal radiation therapy

The use of radiation therapy has led to a significant improvement in the survival rate of patients treated for Hodgkin's disease, breast cancer and other malignances, however as patients live longer the potentially serious adverse effects of radiation on the heart raised increasing concern. A retrospective chart review was performed to compare two groups of patients, post mediastinal radiation therapy group [MRT] and patients who did not receive radiation [a control group] who underwent open heart surgery for postoperative complications and mortality. Radiation can affect all structures in the heart, coronaries, conductive system, valves and pericardium, we demonstrated an increase incidence of postoperative inotropic support and the need for pacemaker implantation as well as infection rate in MRT group compared to the control group, the mortality rate was higher as well. Patients who receive mediastinal radiation therapy before cardiac surgery suffer from more post-operative cardiac complications than patients who have not been exposed to radiation therapy

Overall outcome after cardiac surgery in dialysis patients

Purpose: Cardiovascular illness is an important contributor to the morbidity of kidney disease, and it includes a variety of spectrum from left ventricular enlargement to myocardial infarction and peripheral vascular disease [1] Cardiac surgery in patients receiving dialysis has a high morbidity and mortality [2] secondary to higher risk population of these patients, the aim of the study was to compare dialysis patient to their peers of high risk non dialysis patient

Methods: This is prospective study was done on patients undergoing open heart surgery in a single institutional hospital where 2 groups were identified, patients on dialysis and non dialysis patients, demographic data and post operative morbidity and mortality was studied .Since patients on dialysis are higher risk patients we decided to compare them to non dialysis patient using univariate and severity adjusted analysis

Results: Severity adjusted p value indicates that dialysis patients have reduced chance of morbidity relative to their same severity non dialysis patients [odd ratio of morbidity=0.47 [95% CI 0.25-0.87]

Conclusion: Dialysis patient are higher risk patients compared to non dialysis patients and has a higher rates of morbidity and mortality but when comparing these patient to non dialysis patient who have the same high risk they actually do better

Outcome predictors in lung transplant patients

Purpose: Lung transplantation has become an established treatment for selected patients with end stage pulmonary disease. The Alveolar -arterial [A-a] gradient shown to be useful marker of post-operative pulmonary morbidity in patients undergoing single lung transplantation [1] The purpose of this study was to determine the utility of the [A-a] gradient in predicting post-operative morbidity and mortality in patients undergoing single as well as double lung transplantation

Methods: A retrospective study was done in a single institution where 25 patient underwent lung transplantation, [A-a] gradients were calculated for each patient pre-operative, post-operative and a variable post-operative minus pre-operative, linear regression was performed to assess the relationship between each A-a gradient variable and overall morbidity [including infection, neurological, respiratory and renal complications]as well as mortality

Results: Using the [A-a] gradient measurement peri-operatively we found that there was a significant relation to overall morbidity. Patients with a 50 point higher [A-a] gradient change post-operatively from pre-operative value would be 1.8 times more likely to have morbidity

Conclusion: This study shows that using the pre-operative and post-operative [A-a] gradient can be useful and easy tool to predict post-operative morbidity

Preoperative troponin I level as a predictor of post operative outcome after cardiac surgery versus coronary angioplasty

Purpose: Studies had been shown that the post operative morbidity and mortality after cardiac surgery increases in patients with positive preoperative cardiac Troponin I level [cTnI]. Whether post angioplasty complications in these patients has equivalent effect was not determined

Methods: A combined prospective and retrospective study was done, patients with negative and positive preoperative troponin were detected and post operative complications were studied prospectively in the preoperative negative cTnI group control group 1] and positive cTnI who underwent cardiac surgery [positive for cardiac surgery group 2], the positive preoperative cTnI group who underwent angioplasty were retrospective studied [positive for angioplasty 3]

Results: The incidence of postoperative complications in both group 2 and 3 were higher than the control group however there was no difference in the outcome whether patients with reoperative positive cTnI underwent cardiac surgery or angioplasty. Mortality rate was 13%, 14% and 5.3% in group 2 and 3 compared to the control group respectively as well as post operative myocardial infarction was 5%, 4.5% and 1.8% respectively

Conclusion: Postoperative morbidity and mortality are similarly higher in patients with preoperative positive cTnI level whether they underwent cardiac surgery or coronary angioplasty [PTCA]

Intra-operative hemodynamic changes and postoperative outcome in patients with carotid stenosis undergoing carotid endartrectomy versus carotid artery stent

Purpose: Carotid endarterectomy [CEA] has been widely regarded as a treatment of choice for carotid occlusion disease, carotid artery stenting [CAS] has been recently emerged as an alternative specially for high risk patients, during surgery patients experience hemodynamic instability specially with clamping or ballooning that may lead to post-operative myocardial infarction and stroke which is considered the most common complications. We decided to compare the morbidity [specially cardiac and neurological outcome] and mortality between the two procedures

Methods: A randomized study was done, 47 patients were divided into two groups CEA and CAS, demographical data and pre-operative assessment as well intra-operative and post operative complications were recorded, patients who could not tolerate to lay flat or with congestive heart failure were excluded

Results: There was no statistical difference in the demographic and pre-operative morbidity associated with carotid artery disease in both groups, intra and post-operative hemodynamic instability on the other hand was statistically significant in CAS 12% compared to 5% in CEA group as well as the incidence of bradycardia was 68% compered to 39% in CEA [p<0.05] as regards the post operative incidence of MI and stroke there was no difference

Conclusion: Percutaneous carotid stenting provides comparable cardiac and neurological outcome to carotid enarterectomy despite increase in hemodynamic instability associated with stent placement which may be related to technical and mechanical factors