Clinical efficacy of convalescent plasma for treatment of COVID-19 infections: Results of a multicenter clinical study.

Since Dec. 2019 the new coronavirus (SARS-CoV-2) has infected millions and claimed life of several hundred thousand worldwide. However, so far no approved vaccine or drug therapy is available for treatment of virus infection. Convalescent plasma has been considered a potential modality for COVID-19 infection. One hundred eighty-nine COVID-19 positive patients including 115 patients in plasma therapy group and 74 patients in control group, registered in the hospitals with confirmed COVID-19 infection, entered this multi-center clinical study. Comparison of outcomes including all-cause mortality, total hospitalization days and patients' need for intubation between the two patient groups shows that total of 98 (98.2 %) of patients who received convalescent plasma were discharged from hospital which is substantially higher compared to 56 (78.7 %) patients in control group. Length of hospitalization days was significantly lower (9.54 days) in convalescent plasma group compared with that of control group (12.88 days). Only 8 patients (7%) in convalescent plasma group required intubation while that was 20 % in control group. This clinical study provides strong evidence to support the efficacy of convalescent plasma therapy in COVID-19 patients and recommends this treatment for management of these patients. Clinical efficacy, immediate availability and potential cost effectiveness could be considered as main advantages of convalescent plasma therapy.

Allopurinol as a preventive contrivance after acute ischemic stroke in patients with a high level of serum uric acid: a randomized, controlled trial.

OBJECTIVES: To assess the clinical relevance (functional outcome) of a 3-month allopurinol regimen in patients with high serum uric acid (SUA) levels and acute ischemic stroke without considering the changes in SUA levels. MATERIALS AND METHODS: In a randomized, double-blind, controlled study, 70 patients (45 females, 25 males) with acute ischemic stroke who had elevated levels of SUA were included. They were divided in two 35-patient groups to investigate the effect of 3 months of an allopurinol (200 mg/day) regimen versus placebo on their functional outcome, which was evaluated using a modified Rankin scale. RESULTS: The overall mean age was 68.9 ± 11.33 years (range 27-89). The final favorable functional status (mRS = 0-2) was 23 (65.7%) and 14 (40.0%) in the treated and placebo groups, respectively, which was strongly associated with allopurinol consumption (OR = 4.646, p = 0.014) and age ≤70 years (OR = 0.139, p = 0.005) in patients with ischemic stroke after adjusting for confounders. There was no significant difference in death between allopurinol-treated cases (3; 8.6%) and placebo-treated ones (6; 17.2%; p = 0.278). CONCLUSION: Allopurinol treatment was well tolerated and improved the 3-month functional status of patients with acute ischemic stroke who had high levels of SUA without considering the decreasing effect of allopurinol on SUA.

Predictors and early outcome of prolonged mechanical ventilation in contemporary heart valve surgery.

BACKGROUND: During last decades mechanical ventilation has been an important support in the postoperative management of patients undergoing cardiac surgery. This study was designed to determine the predictors of prolonged mechanical ventilation (PMV) in patients undergoing heart valve surgery. METHODS: This retrospective study considered of 1056 patients who underwent isolated valve surgery at Tehran Heart Center from March 2002 to March 2009. PMV is considered as mechanical ventilation period of > or =24 hours at postoperative hospital stay in this study. RESULTS: PMV occurred in 6.6% of patients. Initial ventilation hours, atrial fibrillation, cardiac arrest and reintubation were the most prevalent postoperative complications. Preoperative renal failure, postoperative stroke, intra aortic balloon pump insertion, emergent operation, complete heart block, longer perfusion time were independent predictors of PMV in our patients. CONCLUSION: PMV is associated with significant comorbidities and increased hospital mortality. Strategies to delineate the patients at risk and to modify these risk factors by prophylactic measures should probably lead to a lower incidence of prolonged mechanical ventilation for patients undergoing isolated valve surgery.

Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery.

INTRODUCTION AND OBJECTIVES: Atrial arrhythmias occur after cardiac surgery in 10-65% of patients. The most common postoperative arrhythmia is atrial fibrillation (AF). METHODS: The Tehran Heart Center Cardiovascular Research database (of 15 580 patients) was used to identify all patients who developed any form of AF as a postoperative complication following their first cardiac surgery (e.g. for coronary artery bypass grafting [CABG], valve surgery or both), with and without cardiopulmonary bypass, between June 2002 and March 2008. RESULTS: Of the 15 580 patients who underwent a first cardiac surgery, 11 435 (73.4%) were male and their mean age was 58.16+/-10.11 years. New-onset AF developed postoperatively in 1129 (7.2%). New-onset AF occurred most frequently in patients who were aged > or =60 years and who had no history of beta-blocker use. In addition, patients were more likely to develop new-onset AF if they had valve surgery alone (16.5%) or CABG plus valve surgery combined (9.6%), needed intra-aortic balloon counterpulsation (IABC), or had a long cardiopulmonary bypass time. Multivariate analysis identified the following predictors of postoperative AF: older age, history of renal failure, congestive heart disease, operation type, longer perfusion time, and use of IABC. The incidence of early readmission (4.4%) was significantly higher in patients with postoperative AF, as was the duration of hospitalization, both overall and postoperatively. The short-term postoperative mortality rate was 3.8%. CONCLUSIONS: Atrial fibrillation frequently develops after cardiac surgery and is associated not only with increased morbidity and mortality, but also with increased use of health-care resources.

Factores determinantes de fibrilación auricular postoperatoria y el uso de recursos en cirugía cardiaca / Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery

Introducción y objetivos. Las arritmias auriculares tras cirugía cardiaca se dan en un 10-65% de los pacientes. La fibrilación auricular (FA) es la arritmia más frecuente tras la cirugía cardiaca. Métodos. Se utilizó la base de datos para investigación cardiovascular del Tehran Heart Center (15.580 pacientes) para identificar a todos los pacientes que presentaron algún tipo de FA como complicación postoperatoria tras su primera intervención de cirugía cardiaca (bypass arterial coronario, cirugía valvular o bypass más cirugía valvular) con o sin bypass cardiopulmonar (BCP), entre junio de 2002 y marzo de 2008. Resultados. De los 15.580 pacientes a los que se practicó una primera operación de cirugía cardiaca, 11.435 (73,4%) eran varones con una media de edad de 58,16 ± 10,11 años. Se produjo una FA postoperatoria de nueva aparición en 1.129 (7,2%) de estos pacientes. La FA de nueva aparición fue más frecuente en los pacientes de edad ≥ 60 años que no tenían antecedentes de tratamiento con bloqueadores beta. Los pacientes con una FA de nueva aparición tenían también mayor probabilidad de que se les hubiera practicado una operación de cirugía valvular (16,5%) o de bypass más cirugía valvular (9,6%), así como de necesidad de balón de contrapulsación intraaórtico (BCIA) y un tiempo de bypass cardiopulmonar mayor. Los factores predictivos de la aparición de FA postoperatoria en el análisis multivariable fueron la mayor edad, los antecedentes de insuficiencia renal, la insuficiencia cardiaca congestiva, el tipo de operación, el mayor tiempo de perfusión y el uso de BCIA. En los pacientes con FA postoperatoria hubo una incidencia significativamente superior de reingresos tempranos (4,4%), así como una duración de la hospitalización (DdH) y una DdH postoperatoria más prolongadas. La tasa de mortalidad postoperatoria temprana fue del 3,8%. Conclusiones. La aparición de FA es frecuente tras la cirugía cardiaca y se asocia no sólo a un aumento de la morbimortalidad, sino también a un incremento de la utilización de recursos (AU)

Introduction and objectives. Atrial arrhythmias occur after cardiac surgery in 10-65% of patients. The most common postoperative arrhythmia is atrial fibrillation (AF). Methods. The Tehran Heart Center Cardiovascular Research database (of 15 580 patients) was used to identify all patients who developed any form of AF as a postoperative complication following their first cardiac surgery (e.g. for coronary artery bypass grafting [CABG], valve surgery or both), with and without cardiopulmonary bypass, between June 2002 and March 2008. Results. Of the 15 580 patients who underwent a first cardiac surgery, 11 435 (73.4%) were male and their mean age was 58.16±10.11 years. New-onset AF developed postoperatively in 1129 (7.2%). New-onset AF occurred most frequently in patients who were aged ≥60 years and who had no history of beta-blocker use. In addition, patients were more likely to develop new-onset AF if they had valve surgery alone (16.5%) or CABG plus valve surgery combined (9.6%), needed intra-aortic balloon counterpulsation (IABC), or had a long cardiopulmonary bypass time. Multivariate analysis identified the following predictors of postoperative AF: older age, history of renal failure, congestive heart disease, operation type, longer perfusion time, and use of IABC. The incidence of early readmission (4.4%) was significantly higher in patients with postoperative AF, as was the duration of hospitalization, both overall and postoperatively. The short-term postoperative mortality rate was 3.8%. Conclusions. Atrial fibrillation frequently develops after cardiac surgery and is associated not only with increased morbidity and mortality, but also with increased use of health-care resources (AU)

Prophylactic ventral cardiac denervation: does it reduce incidence of atrial fibrillation after coronary artery bypass grafting?

OBJECTIVE: This study assessed the prophylactic effect of ventral cardiac denervation on reducing atrial fibrillation after coronary artery bypass grafting. METHODS: This randomized prospective study recruited 220 adult patients (aged 42-79 years) who were scheduled to undergo coronary artery bypass grafting. Of these patients, 110 underwent ventral cardiac denervation in addition to coronary artery bypass grafting and 110 underwent only coronary artery bypass grafting. The demographic, intraoperative, and postoperative factors comprising atrial fibrillation were compared between the 2 groups. In addition, the predictive factors of atrial fibrillation in all 220 cases were assessed. RESULTS: The mean age and the distribution of gender, body mass index, diabetes mellitus, chronic obstructive pulmonary disease, hypertension, hypercholesterolemia, and left main disease were not significantly different between the 2 groups. Atrial fibrillation incidence was significantly different between the groups (P=.025), with an incidence of 20.9% in the ventral cardiac denervation group and 10% in the control group. Atrial fibrillation occurred in 34 of the 220 patients, and ventral cardiac denervation was considered as a variable to evaluate its possible role in the prevention of postoperative atrial fibrillation. Our multivariate analysis showed age (P=.002; odds ratio,1.098; confidence interval, 1.034-1.165) and ventral cardiac denervation (P=.044; odds ratio,2.32; confidence interval, 1022-5.298) as the predictive factors of atrial fibrillation after coronary artery bypass grafting. CONCLUSIONS: Given the surprising results of the present study demonstrating that ventral cardiac denervation is a predictive factor of atrial fibrillation after coronary artery bypass grafting, ventral cardiac denervation should not be routinely considered for the prevention of atrial fibrillation after coronary artery bypass grafting.

Is severely left ventricular dysfunction a predictor of early outcomes in patients with coronary artery bypass graft?

BACKGROUND: Traditionally, the Coronary artery bypass grafting (CABG) surgery outcomes of patients with low ejection fraction (EF) have been worse compared to patients with moderate to good left ventricular function. During the past decade, despite improvements in surgical techniques, the trend in the outcomes of these patients remained unclear. AIM: We sought to determine the effect of left ventricular dysfunction on early mortality and morbidity and to specify predictors of early mortality of isolated CABG in a large group of patients EF≤35%. METHOD: We retrospectively analyzed data of 14 819 consecutive patients undergoing isolated CABG from February 2002 to March 2008 at Tehran Heart Center. Patients were divided into two groups based on their LVEF (EF≤35% and EF>35%). Differences in case-mix between patients with EF≤35% and those without were controlled by constructing a propensity score. RESULTS: Mean age of our patients was 58.7±9.5 years. EF≤35% was present in 1342 (9.1%) of patients. In-hospital mortality was significantly increased univariate in EF≤35%, while this association diminished after confounders were adjusted for by using the propensity score (p=0.242). Following adjustment it was demonstrated that renal failure, cardiac arrest, heart block, infectious complication, total ventilation time, and total ICU hours were more frequent in patients with EF≤35%. CONCLUSION: We demonstrated EF≤35% was not predictor of in-hospital mortality in patients underwent CABG. Careful preoperative patient selection remains essential in patients with EF≤35% undergoing CABG.

Anomalous right-sided pulmonary venous connection to the superior vena cava.

Over the years, different techniques have been introduced for the repair of sinus venosus atrial septal defect (ASD) with anomalous right-sided pulmonary venous connection to the superior vena cava. We report the case of a 9-year-old girl, who presented with dyspnea and peripheral cyanosis. Preoperative echocardiography and angiography findings suggested a partial anomalous pulmonary venous connection. On cardiopulmonary bypass, the ASD was dilated, and the anomalous pulmonary vein was anastomosed to the right atrium and redirected to the left atrium using an intraatrial baffle and a tube graft. The intraoperative and postoperative periods were uneventful, and the patient is currently in good health at 4.5 years' follow-up.

Determinant factors of renal failure after coronary artery bypass grafting with on-pump technique.

OBJECTIVE: The aim of the present study was to investigate the determinant factors of acute renal failure (ARF) after isolated on-pump coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: This was a retrospective study of 13,315 adult patients who underwent isolated CABG with cardiopulmonary bypass (CPB) in Tehran Heart Center from May 2002 to May 2007. The exclusion criteria were age <18, concomitant cardiac and/or noncardiac surgical operations, history of renal failure before surgery, and chronic renal failure requiring dialysis. Preoperative and operative variables were measured, and a multivariate logistic regression model was constructed to identify the independent risk factors for developing renal failure after on-pump CABG. RESULTS: Of the 13,315 patients, 3,347 (25.4%) and 90,883 (74.6%) were females and males, respectively, with a mean age of 58.63 +/- 9.48 years. ARF was detected in 85 (0.6%) of the patients with isolated on-pump CABG. The mean age of the patients was 58.63 +/- 9.48 years, and 25.5% of them were female. The multivariate logistic regression analysis identified age (OR = 1.035; p = 0.002), female gender (OR = 1.622; p = 0.037), history of peripheral vascular disease (PVD) (OR = 2.579; p = 0.042), diabetes mellitus (OR = 1.918; p < 0.001), emergent and urgent surgery (OR = 1.744 and OR = 7.901, respectively; p = 0.003), CPB time >70 min (OR = 1.944; p = 0.007), and intra-aortic balloon pump (IABP) insertion (OR = 10.181; p < 0.001) as the independent risk factors for ARF. CONCLUSION: The data showed that age, female gender, positive history of diabetes and PVD, urgent and emergent surgery, CPB time >70 min, and need for IABP were the independent determinant factors of ARF after on-pump CABG.

The association of opium dependence and postoperative complications following coronary artery bypass graft surgery: a propensity-matched study.

OBJECTIVE: Opium is an overwhelming public health problem in some countries. Different studies have suggested this drug as a risk factor for cardiovascular disease. Although the effect of opium on immune system, lung disease, nephropathy, stroke, and cardiac arrhythmia has been found in different studies, its effect on postoperation complications is not clear yet. The authors conducted this study to assess the effect of opium on post operation in hospital complications among patients who underwent coronary artery bypass graft. DESIGN: The authors retrospectively analyzed the data in this study. SETTING: This study has been done at Tehran Heart Center. PATIENTS: A total of 4,398 patients who had undergone isolated CABG were studied. MAIN OUTCOME MEASURE: Patients who fulfilled the DSM-IV-TR criteria for opium dependence (by smoking) were enrolled as Opium Dependent Patients. Also outcome variables were: Perioperative MI, septicemia, UTI, TIA, continuous coma, prolonged ventilation, pulmonary embolism, renal failure, acute limb ischemia, heart block, AF, mortality. RESULTS: The prevalence of opium dependence was 15.6percent among patients. The authors used a propensity matched model to analyze the relationship between opium and post operation complications. The authors adjusted opium and non-opium dependent patients in all of the baseline preoperative risk factors, so all of the matched patients were same and there was no bias in assessment. CONCLUSION: Opium dependent patients had significantly longer resource utilization. However, no significant relationship was found between opium dependence and other cardiac and non cardiac in hospital complications.