Long-term outcome after pneumonectomy at Siriraj Hospital.

Objective: The purpose of this study is to identify predictors of long term survival following pneumonectomy and compare New York Heart Association (NYHA) functional classification and ECOG performance status before and after surgery at Siriraj Hospital. Methods: All fifty three patients having a pneumonectomy between 1998 and 2009 were retrospectively studied. We compared each patient’s status before and after surgery. The parameters of survival were tested by univariate analysis, the Kaplan-Meier method, and differences in survival were determined by log-rank analysis. Results: There were 35 males (66%) and 18 females (34%) with a mean age (standard deviation) of 51±17 years (range 0.7-82 years). The majority of patients were lung cancer (77%) and destroyed lungs from infectious (12%) diseases. The mean follow-up time was 33 months, median 22 months, standard deviation 24 months, ranging between 0 and 131 months. Post-operative complication occurred in 11% of patients (bronchopleural fistula, bleeding, cardiac herniation and recurrent laryngeal nerve injury). Hospital mortality occurred in 7.5% (4 deaths). Late death occurred in 52.8% (28 deaths) including metastasis 30% (16 patients), pneumonia 19% (10 patients), and miscellaneous causes 3.7% (2 patients). Using univariate analysis, non lung cancer (P = 0.035) and the slow growing lung cancer (P = 0.007) were independent predictors of long term survival. The decrease in NYHA functional classification and ECOG performance status after surgery was not significant. Conclusion: Long-term survival after pneumonectomy for lung cancer occurred in 20% and non lung cancer in 60% of patients. Non lung cancer and the slow growing lung cancer were independent predictors of long term survival. Decreases in NYHA functional classification and ECOG performance status after pneumonectomy were not significant.

Comparison of intensity of platelet aggregation between patients receiving low and high aspirin dosage in post CABG patients.

Background: Aspirin used after coronary artery bypass graft surgery (CABG) improved patient survival and reduced graft thrombosis. However, individual variations in the antiplatelet effect of aspirin have been reported among CABG patients. Objective: To compare the intensity of platelet aggregation between patients receiving low and high aspirin dosage in post CABG patients. Methods: We prospectively studied the effect of aspirin dosage on platelet aggregation in 100 CABG patients. Oral aspirin was discontinued prior to CABG and re-started within 12 hours after CABG. Blood samples were collected and transferred to a laboratory prior to surgery then again on postoperative days two and eight for platelet aggregation test and platelet count within three hours after venipuncture. Results: One hundred patients (sixty five male and thirty five female patients) post coronary artery bypass graft (CABG) were evaluated for eligibility to enter the trial. The percentage of platelet aggregation was compared between low dose (<100 mg/day), and high dose (>100 mg/day) aspirin, at postoperative CABG days 2 and 8, which showed no significant difference for the platelet aggregation (p = 0.161 post CABG day 2 and p = 0.098 post CABG day 8). Conclusion: Low dosage aspirin should be used in post CABG patients because the intensity of platelet aggregation between patients post CABG receiving low and high aspirin dosage were not different, while the prophylactic effect of the low aspirin dosage in reducing the risk of cardiovascular events proved equally as effective as the high aspirin dosage.

A successful endovascular treatment for complicated acute type B aortic dissection.

A young male patient with Marfan syndrome suffered from acute type B aortic dissection with visceral organ malperfusion. The thoracic stent grafting was urgently performed with a successful outcome. This study reports a potential endovascular approach to treat complicated acute type B aortic dissection in a Marfan syndrome patient.

Endovascular repair in acute traumatic disruption of the thoracic aorta.

Objective: To evaluate thoracic endovascular repair in patients with blunt traumatic thoracic aortic disruption. Methods: From February 2002 to August 2004, five multitrauma patients (4 males, 1 female) from motor vehicle accidents presented with traumatic thoracic aortic disruption. The mean age of the patients was 42 years (22-70 years). All were treated by acute endovascular repair with a covered stent graft through the femoral artery approach without administration of heparin. Results: The mean operative time was 101 minutes (75-125 minutes) with negligible intraoperative blood loss. There was no intervention related mortality and no paraplegia. In all cases the subclavian artery was over-stented intentionally, no arm ischemia was observed. One patient died after 1 week due to unrelated causes. Another patient died after 1 year from cardiomyopathy. Follow-ups of the other 3 patients (median 30 months) show good results. There was no endoleak, no stent-graft migration and no structural failure. Conclusion: Endovascular repair in acute traumatic disruption of the thoracic aorta is technically feasible, safe and with good midterm follow-up results. This procedure is an effective alternative to open surgery for multitrauma and high-risk patients.

Early postoperative coronary angiography result in Off-pump Coronary Artery Bypass (OPCAB) patients.

Objective : The purpose of this study was to evaluate the early results of coronary artery bypass without cardiopulmonary bypass (off-pump coronary artery bypass - OPCAB) at Siriraj Hospital. Patients and methods : From September, 2001 to April 2002, eight selected coronary artery disease patients were operated on using the off-pump coronary artery bypass technique. Operative data were collected and postoperative coronary angiography was studied in all patients before discharge. Results : There were no death and no need to resort to the conventional procedure. Postoperative coronary angiography revealed good patency of all 17 grafts. Postoperative cardiac enzymes were elevated in one patient. Conclusion : The early of OPCAB in this study showed good outcomes. Early postoperative angiography demonstrated excellent anastormoses. This procedure needed fewer blood transfusions than the conventional technique. However, long-term follow up of these procedures should be evaluated.

A multidisciplinary approach to atrial fibrillation.

We report a case with mitral regurgitation and atrial fibrillation and discuss the management of atrial fibrillation. The successful result of combining of mitral valve repair and simple pulmonary vein isolation in a single procedure is presented.