Efficacy of human prothrombin complex concentrate in the treatment of warfarin overdose in patients receiving warfarin for mechanical heart valve replacement.

Warfarin, a widely utilized anticoagulant, is paramount for preventing thromboembolic events in patients with mechanical heart valve replacements. However, its narrow therapeutic index can lead to over-anticoagulation and overdose, resulting in serious health risks. This study examines the efficacy of human prothrombin complex concentrate (PCC) in managing warfarin overdose, in comparison with traditional treatments. A retrospective analysis was conducted on 162 adults who presented with warfarin overdose (INR > 5.0) at a tertiary care hospital between 2016 and 2020. Participants were divided into 2 groups-those treated with PCC (n = 57) and those treated with conventional methods (n = 105), including vitamin K and fresh frozen plasma. The primary outcome was the rate of reaching the target (International Normalized Ratio) INR within 24 hours. Secondary outcomes included transfusion requirements, thromboembolic events, adverse reactions, 30-day mortality, and length of hospital stay. PCC demonstrated significant efficacy, with 89.5% of patients achieving the target INR within 24 hours, compared to 64.8% in the control group (P < .05). The PCC group also had reduced transfusion requirements and a shorter average hospital stay. There was no significant difference in thromboembolic events or adverse reactions between the 2 groups, and the reduced 30-day mortality in the PCC group was not statistically significant. Human prothrombin complex concentrate is associated with rapid reaching the target INR, decreased transfusion needs, and shortened hospitalization, making it a promising option for warfarin overdose management. While the results are encouraging, larger, multicenter, randomized controlled trials are necessary to further validate these findings and optimize PCC administration protocols.

Impact of Coronary Collateral Circulation of Perioperative Myocardial Damage in High-Risk Patients Undergoing Coronary Artery Bypass Grafting Surgery.

BACKGROUND: Coronary collateral circulation (CCC) is a small vascular formation that allows the connection between the different parts of an epicardial vessel or other vessels. The presence of collateral circulation contributes positively to the course of coronary artery disease (CAD). The aim of this study was to investigate the effect of collateral circulation on myocardial injury and clinical outcomes during coronary artery bypass grafting (CABG) in a high-risk patient group. METHODS: 386 patients who underwent isolated CABG under cardiopulmonary bypass (CPB) were included in the study. Patients were divided into two groups according to the Rentrop scores (n = 225 poor CCC group; and n = 161 good CCC group). Myocardial injury and postoperative clinical results were evaluated as endpoints. RESULTS: The mean age was 62.9 ± 7.5 years, and 61.6% of all patients were male. Postoperative 30-day mortality rate was significantly higher in poor CCC group (4 [1.7%] and 1 [0.6%], P < .001). The frequency of postoperative intraaortic balloon pump (IABP) use (5 [2.2%] and 1 [0.6%], P < .001), low cardiac output syndrome (LCOS) (28 [12.4%] and 10 [6.2%], P < .001) and postoperative atrial fibrillation (35 [15.6%] and 16 [9.9%], P = .038) were significantly higher in poor CCC group. 12th and 24th hour CK-MB and cTn-I values were found to be significantly lower in the good CCC group. CONCLUSION: It is inevitable that the CPB circuit and operation have devastating effects on myocardium in CABG operations. The presence of CCC reduces postoperative myocardial injury, low cardiac output syndrome, and mortality rates.

Comparison of Del Nido and Intermittent Warm Blood Cardioplegia in Coronary Artery Bypass Grafting Surgery.

PURPOSE: In this study, we aim to investigate the efficacy and clinical results of using Del Nido solution (DNS) in coronary artery bypass grafting (CABG) surgery by comparing with intermittent warm blood cardioplegia (IWBC). METHODS: Between March 2017 and February 2018, 297 adult patients who underwent primary isolated CABG surgery with cardiopulmonary bypass (CPB) were included in the study. We used DNS in 112 patients and IWBC was used in 185 patients. We compared both the clinical and the laboratory results. RESULTS: Aortic cross-clamp time, CPB time, and peak glucose level are lower with DNS. But we did not observe any meaningful difference of clinical results between two methods including postoperative myocardial enzyme release. CONCLUSION: Del Nido cardioplegia was developed for immature heart and pediatric surgery. But in our opinion, it is a good and useful alternative to CABG surgery with similar results to IWBC.

The effect of gender on the early results of coronary artery bypass surgery in the younger patients' group / O efeito do gênero sobre os resultados iniciais da cirurgia de revascularização do miocárdio em grupo de pacientes mais jovens

Introduction: In this retrospective study, we aimed to determine the risk factors for coronary artery bypass surgery in patients under 45 years of age, and evaluate the early postoperative results and the effect of gender. Methods: A total of 324 patients under 45 years of age who undergone on-pump coronary artery bypass surgery between April 12, 2004 and January 10, 2012 were included to the study. Patients divided into groups as follows: Group 1 consisted of 269 males (mean age 41.3), Group 2 consisted of 55 females (mean age 41.6). Preoperative risk factors, intraoperative and postoperative data and early mortality rates of the groups were compared. Results: Smoking rate was significantly higher in Group 1. Diabetes mellitus incidence and body mass index were significantly higher in Group 2 (P values P=0.01; P=0.0001; P=0.04 respectively). The aortic cross-clamping and cardiopulmonary bypass time and number of grafts per patient were significantly higher in Group 1 (P values P=0.04; P=0.04; P=0.002 respectively). There were no deaths in either group. Conclusion: We found that gender has no effect on early mortality rates of the coronary bypass surgery patients under 45 years. .

Introdução: Este estudo retrospectivo teve como objetivo determinar os fatores de risco para cirurgia de revascularização do miocárdio em pacientes com menos de 45 anos de idade e avaliar os resultados pós-operatórios precoces e o efeito do gênero. Métodos: Um total de 324 pacientes com menos de 45 anos de idade, que submeteram à cirurgia de revascularização miocárdica entre 12 de abril de 2004 e 10 de janeiro de 2012 foram incluídos no estudo. Os pacientes divididos em dois grupos: Grupo 1, composto por 269 homens (idade média 41,3 anos), Grupo 2, composto por 55 mulheres (idade média 41,6 anos). Fatores de risco pré-operatórios, dados intraoperatórios e pós-operatórios e mortalidade precoce dos grupos foram comparados. Resultados: A taxa de tabagismo foi significativamente maior no grupo 1. Incidência de diabetes mellitus e massa corporal foram significativamente maiores no grupo 2 (valor de P: P=0,01, P=0,0001, P=0,04, respectivamente). O pinçamento aórtico e tempo de circulação extracorpórea e número de enxertos por paciente foi significativamente maior no grupo 1 (valor de P: P=0,04, P=0,04, P=0,002, respectivamente). Não ocorreram mortes em ambos os grupos. Conclusão: O gênero não tem efeito sobre as taxas de mortalidade precoce dos pacientes de cirurgia de revascularização do miocárdio com menos de 45 anos. .

Risk factors for intraaortic balloon pump use in coronary artery bypass surgery.

OBJECTIVES: The study was aimed at investigating the risk factors of using an intraaortic balloon pump (IABP) in coronary artery bypass surgery and presenting the authors' clinical experience of IABP use. MATERIAL AND METHODS: The study included 1094 patients who underwent coronary artery bypass surgery at the authors' clinic between January 2009 and December 2011. A comparison was made between 17 patients in whom an IABP was used and 1077 patients in whom it was not used. RESULTS: An intraaortic balloon pump was used in 17 patients (1.55%) out of 1094 patients who underwent isolated coronary artery bypass surgery. The ratio of patients who had had preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50% and emergency surgery in Group 1 were higher than in Group 2 (p < 0.05). The total cardiopulmonary bypass time of Group 1 was found to be longer than that of Group 2 (p < 0.05). The demand for inotropics after weaning from cardiopulmonary bypass was greater in Group 1 than in Group 2 (p < 0.05). The need for reoperation (because of bleeding) was higher in Group 1 than in Group 2 (p < 0.05). The patients' stay on the intensive care unit was longer in Group 1 than in Group 2 (p < 0.05). Mortality rates were 29.4% in Group 1 and 1.2% in Group 2 (p < 0.05). CONCLUSIONS: Preoperative myocardial infarction within the preceding 30 days, left main coronary artery stenosis of more than 50%, emergency surgery and long cardiopulmonary bypass time are important risk factors for IABP use in coronary artery bypass surgery.

Coronary artery bypass surgery: beating heart or cardiopulmonary bypass?

In this study, we examined the early results for patients who underwent beating heart coronary bypass surgery and compared these results with those of conventional coronary bypass surgery.A total of 1094 patients who underwent isolated coronary artery bypass surgery between January 2009 and December 2011 in our clinic were included in this study. Seventy-three patients in whom cardiopulmonary bypass was not used (group 1) were compared to 1021 patients in whom cardiopulmonary bypass was used (group 2).The mean age was 60.7 ± 9.3 in group 1 and 58.9 ± 9.7 in group 2 (P > 0.05). There was no significant difference between the two groups in terms of gender, or the coexistence of diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and hypertension (P > 0.05). There was no significant difference between group 1 and group 2 in terms of development of postoperative atrial fibrillation (AF), use of an intra-aortic balloon pump, need for re-operation for bleeding, or duration of hospital stay and intensive care unit stay (P > 0.05). The need for inotropic support and the amount of mediastinal drainage were less in group 1 than in group 2 (P = 0.002, P < 0.001). The incidences of postoperative cerebrovascular accident, development of chronic renal failure, and sternal wound infection did not significantly differ between the groups (P > 0.05). There was no mortality in group 1, whereas it was calculated as 1.8% in group 2 (P = 0.63).Beating heart coronary artery bypass surgery decreases the need for inotropic support and transfusion.

Early postoperative results for females undergoing isolated coronary artery bypass surgery: comparison of the pre- and postmenopausal periods.

PURPOSE: In this retrospective study, we investigated the demographic data and evaluated our early postoperative results of premenopausal and postmenopausal females who underwent coronary artery bypass graft surgery (CABG). METHODS: A total of 730 female patients who underwent CABG between April 2004 and January 2012 were included in the study. Patients were divided into two groups based on whether they were pre- (group 1) or postmenopausal (group 2). The groups were compared in terms of the demographic and peri-operative parameters. RESULTS: Smoking and the preoperative hematocrit levels were higher in group 1, whereas the incidence of hypertension and obesity and the European system for cardiac operative risk evaluation values were higher in group 2 (p values <0.01; <0.01; <0.01; 0.004 and <0.01 respectively). The utilization of a left internal mammary artery graft and the postoperative drainage volumes were higher in group 1; however, the number of grafts per patient, cardiopulmonary bypass duration, number of patients who needed inotropic support, blood transfusion volumes, the duration of ventilatory support and the hospital stay were higher in group 2 (p values 0.038; 0.040; 0.026; 0.032; 0.014; 0.001; <0.01 and <0.01, respectively). CONCLUSIONS: Although the mortality rates were not significantly different, postmenopausal patients require more intensive postoperative care in comparison to premenopausal patients following CABG.

The effect of gender on the early results of coronary artery bypass surgery in the younger patients' group.

INTRODUCTION: In this retrospective study, we aimed to determine the risk factors for coronary artery bypass surgery in patients under 45 years of age, and evaluate the early postoperative results and the effect of gender. METHODS: A total of 324 patients under 45 years of age who undergone on-pump coronary artery bypass surgery between April 12, 2004 and January 10, 2012 were included to the study. Patients divided into groups as follows: Group 1 consisted of 269 males (mean age 41.3), Group 2 consisted of 55 females (mean age 41.6). Preoperative risk factors, intraoperative and postoperative data and early mortality rates of the groups were compared. RESULTS: Smoking rate was significantly higher in Group 1. Diabetes mellitus incidence and body mass index were significantly higher in Group 2 (P values P=0.01; P=0.0001; P=0.04 respectively). The aortic cross-clamping and cardiopulmonary bypass time and number of grafts per patient were significantly higher in Group 1 (P values P=0.04; P=0.04; P=0.002 respectively). There were no deaths in either group. CONCLUSION: We found that gender has no effect on early mortality rates of the coronary bypass surgery patients under 45 years.

Risk factors for stroke following coronary artery bypass operations.

BACKGROUND: Although the overall complication rates have been decreased significantly in recent years, stroke rates still remain high in patients undergoing coronary bypass operations. This study is designed to evaluate the risk factors for stroke in patients who had undergone coronary artery bypass surgery in an 8-year period in our clinic. METHODS: Between 1995 and 2003, 8547 coronary artery operations under cardiopulmonary bypass were performed. Retrospective analysis of the patient files revealed that 75 (0.9%) patients had stroke in the early postoperative period. RESULTS: Mean age of these patients was 62.3 +/- 9.5 years, and 54 (72%) were males. Stroke rate was 1.2% between 1995 and 1998 and this was significantly higher from the stroke rate (0.7%) of the period 1998 to 2003 (p = 0.03). Major technical differences between these two periods were the routine application of preoperative carotid arteries Doppler evaluation and intraoperative epiaortic echocardiography after 1998. Higher age (p = 0.000), female sex (p = 0.005), smoking (p = 0.03), presence of diabetes mellitus (p = 0.01), hypertension (p = 0.008), and left main coronary artery disease (p = 0.001), carotid surgery (p = 0.000), and peripheral vascular disease (p = 0.049) were identified as important risk factors in univariate analysis for stroke development. Higher age (p = 0.000; OR = 21.38), left main coronary artery disease (p = 0.007; OR = 7.26), peripheral vascular disease (p = 0.050; OR = 3.08), and operation date before 1998 (p = 0.012; OR = 6.33) were identified as important risk factors in logistic regression analysis. According to intraoperative epiaortic ultrasonography, operative strategy was changed in 9% of patients. Thirty-seven (49.3%) of the stroke patients died. Female sex (p = 0.023; OR = 5.18) and preoperative hypertension (p = 0.045; OR = 4.03) were observed as significant risk factors for mortality after stroke. CONCLUSION: Development of stroke is one of the major reasons of mortality after coronary artery bypass operations. It is essential to take all the measures to prevent this complication, especially in patients with known risk factors. Evaluation of carotid arteries prior to operation and application of routine intraoperative epiaortic echocardiography may in part eliminate stroke.

Pregnancy after mechanical mitral valve replacement.

BACKGROUND AND AIM OF THE STUDY: Forty-six pregnancies among 32 patients after mitral valve replacement (MVR) were reviewed. Prosthetic valve-related complications, and outcome of pregnancy including feto-maternal mortality and morbidity for different anticoagulation regimens are presented and discussed. METHODS: Among 521 women of fertile age undergoing MVR with a St. Jude Medical mechanical prosthesis, 32 patients developed a total of 46 pregnancies. Average patient follow up was 5 +/- 4 years (range: 10 months-17 years); total follow up was 155 patient years (pt-yr). Follow up commenced at onset of the first pregnancy. RESULTS: Ten-year Kaplan-Meier survival estimate was 94 +/- 6%; 10-year freedom from valve-related events was 33 +/- 14%. Rates for embolism, anticoagulation-related bleeding and mechanical valve thrombosis were 4.5%, 3.2% and 2.6% per pt-yr, respectively. Among 30 patients receiving uninterrupted low-dose oral warfarin plus aspirin throughout pregnancy, three had normal deliveries, two had premature births, one had a low birth weight, seven had spontaneous abortions, and 17 had therapeutic abortions. By contrast, among eight patients who discontinued anticoagulation despite medical advice, seven had normal-term deliveries without thromboembolic complications, and spontaneous abortion occurred in one patient. Of the five women taking low molecular-weight heparin regimen, three had normal deliveries, one had a premature birth, and one an abortion. Two patients taking warfarin replaced by heparin in the first trimester and in the last two weeks, had term deliveries. One of these women developed left atrial thrombus in the third trimester while receiving heparin; after switching back to warfarin, the thrombus dissolved spontaneously. Another patient on heparin throughout the gestation had an uneventful gestation period that resulted in term delivery. There were four cases of prosthetic valve thrombosis during the postpartum period; all of these developed in women who ceased anticoagulation during pregnancy. CONCLUSION: There were no congenital malformations or maternal mortality/morbidity during pregnancy in this series of 20 live births, probably due to the low-dose anticoagulation regimen used. However, anticoagulation cessation was associated with a high prosthetic valve thrombosis rate in the postpartum period, even when a new-generation prosthetic valve of unique design and expected low thrombogenicity was implanted.

[The efficiency of fast track protocol in elderly patients who underwent coronary artery surgery]. / Koroner arter cerrahisi uygulanan yasli hastalarda "fast track" protokolünün etkinligi.

OBJECTIVE: This study is planned to display the efficiency of fast track protocol and its difference from the conventional anesthesia in patients older than 65 years. METHODS: One hundred patients older than 65 years underwent coronary artery surgery between October 2000-March 2001 in cardiovascular surgery clinic were considered in this study. Fifty patients in whom fast track protocol was applied were included into the study group, group A; fifty patients underwent conventional anesthesia technique were referred to the control group, group B. In both groups demographic characteristics, early hospital mortality, operation time, total drainage, number of transfusions, stay in the intensive care unit and discharge time were recorded. RESULTS: The mean age was 69.0+/-3.0 years in group A and 70.4+/-3.6 years in group B. Early hospital mortality was 2% in group A, 10% in group B (p>0.05). Intensive care unit stay was 22.01+/-10.12 hours in group A and 60.18+/-32.23 hours in group B (p<0.05). Discharge time was on 5.5+/-1.3 day in group A and on 6.9+/-2.3 day in group B (p<0.05). There were no statistical differences between the two groups in respect to other parameters. CONCLUSION: Fast track protocol in patients older than 65 years is a suitable technique by using modern cardiac surgery methods. This protocol is successfully used by selecting the suitable patients and following the patients carefully in the postoperative period.