Ankica Babic

Postoperative management of patients with hemopump support after coronary artery bypass grafting

BACKGROUND In this study, we describe postoperative monitoring, pharmacologic therapy, and hemodynamic responses in patients receiving Hemopump support after postcardiotomy heart failure. METHODS The Hemopump was used in 24 patients with severe left ventricular dysfunction after coronary artery bypass grafting. RESULTS Fourteen patients (58%) were weaned from the Hemopump. Low to moderate doses of a combination of catecholamines, phosphodiesterase inhibitors, vasodilators, and vasoconstrictors were required to optimize Hemopump function and left ventricular unloading. Mean arterial blood pressure, mixed venous oxygen saturation, and urinary output were the most important therapy guidelines. CONCLUSIONS Together with our clinical protocol, the Hemopump effectively unloaded the failing ventricle while maintaining vital-organ perfusion. Doses of vasoactive drugs could be kept low. This approach to treatment provides good conditions for recovery of the stunned myocardium.

Anesthetic management of patients undergoing coronary artery bypass grafting with the use of an axial flow pump and a short-acting β-blocker

Abstract Objectives: To describe the clinical protocol regarding monitoring, pharmacologic interventions, and postoperative care during and after coronary artery bypass grafting (CABG) on the beating heart with an axial flow pump and a short-acting β-blocker. Design: A retrospective study. Setting: A university hospital. Participants: Seventeen patients scheduled for elective CABG. Interventions: Invasive monitoring was performed with either a standard pulmonary artery catheter (PAC) or a surgically placed PAC. An axial flow pump was inserted through a graft sutured to the ascending aorta. A short-acting β-blocker was administered to decrease the motion of the heart and make conditions for CABG adequate and safe. Measurements and Main Results: Compared with baseline measurements, there were significant decreases in mean arterial blood pressure, mixed venous oxygen saturation, and right ventricular ejection fraction during maximal axial flow pump support and β-blockade. No significant change in heart rate was observed at this time. Hemodynamic variables were normalized in the intensive care unit. All patients were separated from the Hemopump without inotropic support, and values of troponin-T, aspartate aminotransferase, and alanine aminotransferase were low postoperatively. All patients survived and were discharged from the hospital. Conclusion: The anesthetic protocol for patients undergoing surgery with a beating heart and the combined use of an axial flow pump and a short-acting β-blocker is outlined. Multiple-vessel CABG on the beating heart was performed with maintenance of an acceptable hemodynamic situation.

Risk factor analysis of Swedish left ventricular assist device (LVAD) patients

BACKGROUND The use of left ventricular assist devices (LVADs) is established as a bridge to heart transplantation. METHODS All Swedish patients on the waiting list for heart transplantation, treated with LVAD since 1993 were retrospectively collected into a database and analyzed in regards to risk factors for mortality and morbidity. RESULTS Fifty-nine patients (46 men) with a median age of 49 years (range, 14 to 69 years), Higgins score median of 9 (range, 3 to 15), EuroScore median of 10 (range, 5 to 17) were investigated. Dominating diagnoses were dilated cardiomyopathy in 61% (n = 36) and ischemic cardiomyopathy in 18.6% (n = 11). The patients were supported with LVAD for a median time of 99.5 days (range, 1 to 873 days). Forty-five (76%) patients received transplants, and 3 (5.1%) patients were weaned from the device. Eleven patients (18.6%) died during LVAD treatment. Risk factor analysis for mortality before heart transplantation showed significance for a high total amount of autologous blood transfusions (p < 0.001), days on mechanical ventilation postoperatively (p < 0.001), prolonged postoperative intensive care unit stay (p = 0.007), and high central venous pressure 24 hours postoperatively and at the final measurement (p = 0.03 and 0.01, respectively). Mortality with LVAD treatment was 18.6% (n = 11). High C-reactive protein (p = 0.001), low mean arterial pressure (p = 0.03), and high cardiac index (p = 0.03) preoperatively were risk factors for development of right ventricular failure during LVAD treatment. CONCLUSIONS The Swedish experience with LVAD as a bridge to heart transplantation was retrospectively collected into a database. This included data from transplant and nontransplant centers. Figures of mortality and morbidity in the database were comparable to international experience. Specific risk factors were difficult to define retrospectively as a result of different protocols for follow-up among participating centers.

Hemopump treatment in patients with postcardiotomy heart failure

BACKGROUND This study examined the use of the Hemopump to treat low cardiac output syndrome after cardiopulmonary bypass. METHODS We used the Hemopump temporary cardiac assist system in 29 patients with severe left ventricular dysfunction after open heart operations from September 1991 to November 1994. RESULTS Five patients were excluded from the study due to initial patient/device-related problems. Ten patients died in the operating room or early during the stay in the intensive care unit due to progressive biventricular failure. Fourteen patients (58.3%) were weaned from the device, and all of them were later discharged. In a subgroup of patients (54%) in whom we had a more aggressive approach for early insertion of the pump, the survival rate was 85%. Preoperative Higging risk score was significantly related to survival. CONCLUSIONS The Hemopump can effectively unload a failing left ventricle with preservation of multiorgan perfusion. A minor decrease in kidney function was observed in most patients, but none of the surviving patients needed hemodialysis. One patient required a short period of peritoneal dialysis to get rid of fluid overload. Hemolysis or platelet dysfunction was not a clinical problem.

A Novel Model for Screening Aortic Stenosis Using Phonocardiogram

This study presents an algorithm for screening aortic stenosis, based on heart sound signal processing. It benefits from an artificial intelligent-based (AI-based) model using a multi-layer perceptron neural network. The AI-based model learns disease related murmurs using non-stationary features of the murmurs. Performance of the model is statistically evaluated using two different databases, one of children and the other of elderly volunteers with normal heart condition and aortic stenosis. Results showed a 95% confidence interval of the high accuracy/sensitivity (84.1%-86.0%)/(86.0%-88.4%) thus exhibiting a superior performance to a cardiologist who relies on the conventional auscultation. The study suggests including the heart sound signal in the clinical decision making due to its potential to improve the screening accuracy.

A Hybrid Model for Diagnosing Sever Aortic Stenosis in Asymptomatic Patients using Phonocardiogram

This study presents a screening algorithm for severe aortic stenosis (AS), based on a processing method for phonocardiographic (PCG) signal. The processing method employs a hybrid model, constitute ...

Data Mining in Cancer Registries: A Case for Design Studies

Cancer registries are created, managed and data mined to gain knowledge about long term patient outcomes, effects of medication, clinical factors influencing patients’ wellbeing. Equally important is the insight into the cost effectiveness of cancer treatments, and securing data input from different medical centers and enable competent data analysis and meaningful results. Interest among different user groups (physicians, researchers, health care administrators, policy makers) cerates expectations regarding the results and active role in the development and in interactive use of the information. This paper discusses several design cases in which data mining could be implemented to enable efficient and user friendly knowledge extraction. Three important design cases have been identified following the pathways that the users typically make: 1. ensemble data mining from long term national registries; 2. ensemble data mining form the dedicated clinical web-databases; 3. ensemble distributed data mining and analysis.

Case Based Reasoning in a Web Based Decision Support System for Thoracic Surgery

Case Based Reasoning (CBR) methodology provides means of collecting patients cases and retrieving them following the clinical criteria. By studying previously treated patients with similar backgrounds, the physician can get a better base for deciding on treatment for a current patient and be better prepared for complications that might occur during and after surgery. This could be taken advantage of when there is not enough data for a statistical analysis, but electronic patient records that provide all the relevant information to assure a timely and accurate clinical insight into a patient particular situation.

Cherry: mobile application for children with cancer.

The Cherry project seeks to address the information needs of young cancer patients, their parents, and health care providers. It aims at helping the patients to understand various aspects of their disease and treatment, and allow them to assess and record their disease related quality of life. It uses elements of social media to offer a meeting point with the physician and peers. Information is presented in a way that is both understandable and appealing to young children in school age and adolescents. Preschool children will be studied as a separate user group to address their needs and possibilities to meet them. The Cherry system wants to utilize Internet and mobile technologies to benefit patient outcome.

Mobile-supported life charting for bipolar patients - user requirements study.

It is assumed that bipolar disorder patients can benefit from monitoring their mood, sleep, medicine intake and behavior which could be both done by patients themselves and in cooperation with health care professionals. This study aims at understanding what is required from a computerized system, as seen from the view of therapists and the patients, and how the newer mobile technologies (smart phones and tablets) can be utilized to support development of such a system. The study focuses on several existing solutions available either freely or on the market. Then these solutions are evaluated by both patients and medical professionals as a part of the system requirements study to be used in a new system development that will utilize mobile technologies to support the performance and patient outcomes.