Nermir Granov

eComment: Rationalizing the use of assisted venous drainage during minimally invasive valve surgery

Nomenclature Historical Pages-1.80 m , AVD is unlikely to be required, and, therefore, 2 should not be routinely included in the CPB circuit unless required intraoperatively. This rationale would also have cost-saving implications. Our study also suffers a number of limitations. First, despite all data being prospectively recorded, it has been analysed retrospectively. Second, the patients were not randomised into either of the two groups. Third, the decision to use AVD was purely at the discretion of the surgeon and the clinical perfusionist, based on their assessment of the venous drainage, and thus a selection bias could exist. Finally, it is a relatively small study. Despite these limitations, we have observed that AVD is not essential in every patient who undergoes mAVR, and is more likely to be used in patients with a larger BSA. Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery. w4x Wang S, Undar A. Vacuum-assisted venous drainage and gaseous microemboli in cardiopulmonary bypass. Limitations using the vacuum-assisted venous drainage technique during cardiopulmonary bypass procedures. drainage method for cardiopulmonary bypass in single-access minimally invasive cardiac surgery: siphon and vacuum-assisted drainage. Vacuum-assisted venous drainage in single-access minimally invasive cardiac surgery. w9x DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Relative importance of venous and arterial resistance in controlling venous return and cardiac output. During minimally invasive valve surgery, a good exposure with a bloodless field is a prerequisite for the ease and success of the surgery. We would like to comment on the issue regarding the use of assisted venous drainage (AVD) raised by the authors w1x. AVD is an important tool available for cardiac surgeons to achieve a bloodless operating field and to empty the heart in order to perform the most important part of the valve surgery. Using direct cannulation of the right atrium might cause crowding of the operative field due to the presence of aortic, venous and venting cannulas as well as aortic-clamp and CO 2 line supply passing through the incision site. Additionally, due to the higher position of the venous cannula in the right atrium, it might need more negative pressure for AVD. Instead, cannulating the femoral vein with double-staged venous cannula (the Remote Access Perfusion Femoral Venousீ cannula, RAP FV; Estech Inc, USA) …

A Difference in Bleeding and Use of Blood and Blood Products in Patients who Were Preoperatively on Aspirin or Dual Antiplatelet Therapy Before Coronary Artery Bypass Grafting

Background Postoperative bleeding in patients who underwent elective coronary artery bypass surgery (CABG) may increase due to preoperative anticoagulant therapy indicative of their disease - acute coronary syndrome or implanted coronary artery stent. Increased bleeding in many cases requires the use of blood and blood derivatives, and sometimes even reoperation. Their use poses the risk of complications, may extend the hospitalization. Methods Our observation retrospective study included 131 patients, 41 treated with aspirin and 90 treated with aspirin and clopidogrel. All underwent for the first time elective on-pump isolated CABG surgery at Clinic for cardiovascular surgery of Clinical Center University of Sarajevo, in period June 2016 to September 2017. The data were collected from patient’s records. Results Out of 131 patients,73.3% were male. The average age was 62. The average total drainage during the first 48 postoperative hours in ASA group was 1027.4±404.9ml and 1049.8±371.3ml in DAPT group. The mean number of whole blood transfusions in the DAPT group washigher compared to ASAgroup. The average number of fresh frozen plasma were higher in the DAPT group 0.84±0.51 compared to the group ASA 0.39±0.07, as well the average thrombocytes transfusions were slightly higher in the DAPT group. Statistical analysis suggests that there is no significant difference between the observed groups (p>0.05). Also, our study did not show a statistically significant difference between arrhythmia onset, the length of mechanical ventilation, use of protamineand tranexamic acid. Reoperation due to postoperative bleeding was recorded in 2 cases in the DAPT group as well as 2 lethal cases. Conclusion In our study, we could not demonstrate less postoperative bleeding and use of blood and blood products in a group of patients who were preoperatively treated with aspirin compared to patients with dual antiplatelet therapy in the elective isolated CABG surgery.

Contrast Media Injector Technology - Renal Safety During Coronarography.

Aim: This study sought to assess whether the volume and osmolarity of contrast media (CM) influences the occurrence of contrast induced nephropathy (CIN) following coronarography procedure. CIN can be defined as an increase in the serum concentration of creatinine greater than a 25% from baseline during the period of 12 to 48 hours after the administration of radiocontrast media. Material and methods: We examined 100 patients without diabetes with serum creatinine concentration from 45 mmol/l to 141 mmol/l and 100 patients with diabetes with serum creatinine concentration from 46 mmol/l to 161 mmol/l who underwent coronary angiography. During procedure they received iso-osmolar contrast medium, Visipaque 320 (iodixanol-320), for group without diabetes from 40 to 340 ml and for group with diabetes from 49 to 310 ml. Results: CIN occurred in 27 (13,5%) of the 200 study patients. There was a trend toward higher prevalence of CIN (16% vs.11%, p = 0.086) in the diabetic group compared with the non-diabetic group. Patient with diabetes received less contrast media, they are younger but number patients with CIN are higher. Conclusion: Increasing contrast media dose is associated with the occurrence of CIN following coronarography. But, another risk factors like diabetes mellitus, old age, male sex and preexisting kidney disease have influence of developing CIN after coronarography.

eComment: Does coma state really stop from operating type A aortic dissection patients?

Nomenclature Historical Pages cardiogram, suggesting coronary ostial involvement, were also observed. Echocardiography documented severe aortic regurgitation. Emergency root replacement with a valved conduit was performed with open distal repair at 24 8C, employing selective antegrade cerebral perfusion. Cardiopulmonary bypass, cardioplegic arrest and antegrade cerebral perfu-sion times were 293, 141, and 22 min. The patient was weaned from extracorporeal perfusion with a 0.04 mgykgy min epinephrine infusion. Neurocognitive function improved after a period of coma, and progressively returned to baseline. The only neurological motor deficit was temporary right upper hemiparesis. Computed tomograms documented a right-sided hemispheric stroke, and reperfused arch vessels despite residual arch dissection (Fig. 2). The patient was discharged from the intensive care unit 36 days after surgery. 3. Discussion Medical therapy for type A acute aortic dissection yields unfavourable results. Although successful repair has been reported, preoperative stroke and especially coma are usually considered contraindications for immediate surgery w2–5x, in spite of the absence of criteria to define irreversible brain damage preoperatively. In the first patient, short-term delayed repair was performed after resuscitative measures in the comatose patient, and the timing of the indication was primarily based on the resumption of initially absent brainstem reflexes, whereas the second patient underwent immediate surgery. The postoperative period was temporarily characterized by profound coma, but late recovery was dramatic in apparently hopeless conditions. This suggests the possible benefits of immediate restoration of cerebral blood flow, even in case of altered or absent brainstem reflexes, and outlines the unreliability of the widely adopted Glas-gow coma scale for patient stratification, as previously outlined in a small case series by our group in which, the preservation of brainstem reflexes was considered a criterion to indicate emergent repair w5x. It might also be speculated that, in case of partial compression of the arch vessels, neurological dysfunction may have a higher potential for recovery. Finally, P300 peak latencies recorded with cognitive evoked potentials represent a useful tool to evaluate neurocognitive function, and are normally increased soon after open-heart operations w6x. In our first patient, the P300 latency recorded-2 months after the acute event, was only mildly increased when compared to healthy controls, and was similar to measurements after valve surgery. Our experience stresses the potential for reversibility of dissection-induced neurological injury, and confirms a higher likelihood of a more severe ischaemic insult in right-sided territories. Extensive arch surgery was not performed because of the absence of …