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Extracorporeal membrane oxygenation in lung transplantation:Indications,techniques and results

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World Journal of Transplantation 2021年第7期11卷 290-302页

作者： Eleonora Faccioli Stefano Terzi Alessandro Pangoni Ivan Lomangino Sara Rossi Andrea Lloret Giorgio Cannone Carlotta Marino Chiara Catelli Andrea Dell'Amore Thoracic Surgery Unit Department of Cardiothoracic and Vascular SciencesUniversity of PadovaPadova 35128Italy

The use of extracorporeal membrane oxygenation(ECMO)in the field of lung transplantation has rapidly expanded over the past 30 *** has become an important tool in an increasing number of specialized centers as a bridge to transplantation and in the intra-operative and/or post-operative *** is an extremely versatile tool in the field of lung transplantation as it can be used and adapted in different configurations with several potential cannulation sites according to the specific need of the *** example,patients who need to be bridged to lung transplantation often have hypercapnic respiratory failure that may preferably benefit from veno-venous(VV)ECMO or peripheral veno-arterial(VA)ECMO in the case of hemodynamic ***,in an intraoperative setting,VV ECMO can be maintained or switched to a VA *** routine use of intra-operative ECMO and its eventual prolongation in the postoperative period has been widely investigated in recent years by several important lung transplantation centers in order to assess the graft function and its potential protective role on primary graft dysfunction and on ischemia-reperfusion *** review will assess the current evidence on the role of ECMO in the different phases of lung transplantation,while analyzing different studies on pre,intra-and post-operative utilization of this extracorporeal support.

关键词： Lung transplantation Extracorporeal membrane oxygenation Bridge to transplantation Support Primary graft dysfunction Ischemia-reperfusion injury

Application effect of thoracoscopic tricuspid valvuloplasty in geriatric patients with tricuspid valve disease

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World Journal of Clinical Cases 2022年第15期10卷 4810-4817页

作者： Wei Jiang Xiao-Mao Long Ke-Quan Wei Si-Cong Li Ze Zhang Bang-Fu He Hui Li department of cardiothoracic and vascular Surgery The People’s Hospital of Guangxi Zhuang Autonomous RegionNanning 530021Guangxi Zhuang Autonomous RegionChina

BACKGROUND Thoracoscopic-assisted technology can ensure that doctors can implement minimally invasive treatment through the right intercostal incision or small incision of the lower *** approach not only can achieve a cardiac correction effect equivalent to that of a thoracotomy but also has the benefit of a clear surgical field ensuring the safety of surgical *** To investigate the effect of thoracoscopic tricuspid valvuloplasty in patients with tricuspid valve *** A total of 41 patients with tricuspid valve disease underwent traditional thoracotomy treatment between January 2018 and June ***-one patients with tricuspid valve disease who underwent thoracoscopic tricuspid valvuloplasty treatment between July 2020 and June 2021 in our hospital were selected as controls for our retrospective *** study group underwent thoracoscopic tricuspid valvuloplasty,while traditional thoracotomy was performed in the control *** operation conditions(the duration of extracorporeal circulation,aorta blocking,endotracheal intubation,and surgery),inflammatory response-related indices(C-reactive protein and white blood cell count)before and after surgery,parameters related to myocardial injury(myocardial troponin T,creatine kinase isoenzyme,creatine kinase,and lactate dehydrogenase),and the incidence of adverse events in the two groups was *** The duration of extracorporeal circulation(109.35±50.31 min),aortic occlusion(94.26±59.61 min),endotracheal intubation(12.59±3.54 h),and hospital stay(5.29±2.34 d)in the study group were shorter than those in the control group(114.91±46.98 min,101.37±61.44 min,13.11±4.01 h,7.09±3.11 d,respectively).The difference in hospital stay between the two groups was statistically significant(P<0.05).Serum C-reactive protein level(4.69±1.35 mg/L)and white blood cell count(6.21±1.97×10^(9)/L)in the study group were found to be not significantly different than those in the control group(5.01±1.1

关键词： Senile tricuspid valve disease Thoracoscopic tricuspid valvuloplasty Inflammatory reaction Myocardial injury

Impact of severe left ventricular dysfunction on mid-term mortality in elderly patients undergoing transcatheter aortic valve implantation

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Journal of Geriatric Cardiology 2016年第4期13卷 290-298页

作者： Giuseppe Ferrante Patrizia Presbitero Paolo Pagnotta Anna Sonia Petronio Nedy Brambilla Federico De Marco Claudia Fiorina Cristina Giannini Fabrizio D'Ascenzo Silvio Klugmann Marco L Rossi Federica Ettori Francesco Bedogni Luca Testa department of Cardiovascular Medicine Humanitas Research Hospital Rozzano Italy cardiothoracic and vascular department Azienda Ospedaliero-Universitaria Pisana Pisa Italy department of Cardiology IRCCS Pol. S. Donato S. Donato Milanese Milan Italy department of lnterventional Cardiology Niguarda Ca' Granda Hospital Milan Italy cardiothoracic department Spedali Civili di Brescia Brescia Italy cardiothoracic department Ospedale Molinette Torino Italy

Background Whether patients with reduced left ventricular function present worse outcome after transcatheter aortic valve implantation （TAVI） is controversial. The aim of this study was to assess the impact of baseline severe impairment of left ventricular ejection fraction （LVEF） on mortality after TAVI. Methods Six-hundred-forty-nine patients with aortic stenosis underwent TAVI with the CoreValve system （92.8%） or the Edwards SAPIEN valve system （7.2%）. Baseline LVEF was measured by the echocardiographic Simpson method. The impact of LVEF 〈 30% on mortality was assessed by Cox regression. Results Patients with LVEF 〈 30% （n = 63）, as compared to those with LVEF 〉 30% （n = 586）, had a higher prevalence of NHYA class 〉 2 （P 〈 0.001） and presented with a higher Euroscore （P 〈 0.001）. Procedural success was similar in both groups （98.4% vs. 97.2%, P = 1）. After a median follow-up of 436 days （25^-75th percentile, 357-737 days）, all-cause mortality [23.8% vs. 23.7%, P = 0.87, hazard ratios （HR）： 0.96, 95% confidence intervals （CI）： 0.56-1.63] and cardiac mortality （19.1% vs. 17.6%, P = 0.89, HR： 1.04, 95% CI： 0.57-1.90） were similar in patients with LVEF 〈 30% as compared to those with LVEF 〉 30%. Thirty-day all-cause mortality was not significantly different between the two groups （11.1% vs. 6.3%, P = 0.14, HR： 1.81, 95% CI： 0.814.06）. Patients with LVEF 〈 30% had a trend toward higher risk of 30-day cardiac mortality （11.1% vs. 5.3%; P = 0.06, HR： 2.16, 95% CI： 0.95-4.90）, which disappeared after multivariable adjustment （P = 0.22）. Conclusions Baseline severe impairment of LVEF is not a predictor of increased short-term and mid-term mortality after TAVI. Selected patients with severe impairment of left ventricular function should not be denied TAVI.

关键词： Left ventricular ejection fraction Mortality Transcatheter aortic valve implantation

Microbiological and Antibiotic Susceptibility Patterns in cardiothoracic and vascular Intensive Care Unit of a Tertiary Level Hospital in Nepal

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World Journal of Cardiovascular Surgery 2023年第3期13卷 61-70页

作者： Bibhush Shrestha Priska Bastola Bishwas Pradhan Arjun Gurung Basanta Ghimire Anil Bhattarai department of cardiothoracic and vascular Anesthesiology Manmohan Cardiothoracic Vascular and Transplant Center Tribhuvan University Kathmandu Nepal department of cardiothoracic and vascular Surgery Manmohan Cardiothoracic Vascular and Transplant Center Tribhuvan University Kathmandu Nepal

Background: Sepsis has been one of the most important conditions for morbidity and mortality of Intensive care unit (ICU) patients. Antibiotics remain one of the major combating factors for it. Indiscriminate antimicrobial usage and poor prescription practices have contributed to the development of multidrug resistant (MDR) organisms. Therefore, the current study was designed to evaluate the spectrum, and susceptibility patterns of pathogens isolated from patients admitted to our cardiothoracic and vascular Intensive care unit. Materials and Methods: The study was conducted in cardiothoracic and vascular ICU of a tertiary care teaching hospital from February 2019 to March 2021. Samples (blood, urine, wound swab, tracheal aspirate, and central venous catheter tip) for culture were taken from all the patients in Sepsis admitted in cardiothoracic and vascular ICU above 18 years of age during the study period. The culture reports (microbiological profile and their susceptibility pattern) were collected and data collection of all enrolled patients was done. Results: Out of the total 128 samples studied 75 (58.5%) were culture positive. The predominant organisms isolated were Gram negative organisms (Klebsiella, Pseudomonas, Acinetobacter, followed by E. coli). The highest prevalence of microbial growth was found in tracheal aspirate (46.8%), followed by blood (21.8%). Antibiotic susceptibility results showed the highest sensitivity of those common pathogens towards higher antibiotics only (especially Polymyxin B and Colistin). Conclusion: The emergence of multidrug resistant organisms and lesser availability of a higher group of antibiotics is a major concern. So there is a need for regular hospital based antibiograms, strict infection control programs, and implementation of antimicrobial stewardship programmes for guiding clinicians in choosing appropriate therapy and preventing the surge of multidrug resistant organisms.

关键词： Sepsis Antibiotics Intensive Care Unit

Prevalence of Preoperative Anemia in Elective Rheumatic Valve Surgery at a Tertiary Care Center in Nepal

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World Journal of Cardiovascular Surgery 2023年第1期13卷 1-9页

作者： Priska Bastola Bibhush Shrestha Bishwas Pradhan Arjun Gurung Basanta Ghimire Anil Bhattarai department of cardiothoracic and vascular Anaesthesiology Manmohan Cardiothoracic Vascular and Transplant Center Tribhuvan University Kathmandu Nepal department of cardiothoracic & vascular Surgery Manmohan Cardiothoracic Vascular and Transplant Center Tribhuvan University Kathmandu Nepal

Background: Rheumatic Valvular Heart disease (RVHD) is common in developing countries often associated with anemia;however its burden is often overlooked. Anemic patients undergoing surgery are likely to receive blood transfusion, increasing morbidity and mortality. Prevalence of anemia in cardiac surgical patients are studied extensively, however its burden in RVHD is lacking. This study attempted to investigate the prevalence of preoperative anemia in RVHD and its effect on blood transfusion, morbidity and mortality in patients undergoing valve surgery. Methods: This is a retrospective observational study conducted at a tertiary care hospital in Nepal. We considered 340 patients who underwent Rheumatic valve replacement surgery from 2014 January to December 2016 and data on their socio-demographic and clinical characteristics were extracted from the patient’s records. The analyses meeting the study objectives were conducted using IBM SPSS v25 for Windows (IBM Statistical Package for Social Sciences, 2015IBM Corporation, New York, United States). Results: The prevalence of no anemia, mild, moderate, and severe anemia was 34.1%, 57.7%, 39.6%, 2.5%, respectively. The units of Red Blood Cell used for transfusion were 1.2 units, 2.0 units, 2.3 units, and 1.6 units in patients without anemia, and those with mild, moderate and severe anemia respectively. The incidence of reexploration was higher in patients with severe anemia as compared to the non anemic with an incidence of 66.6%. A proportion of the patients with no anemia, mild, moderate and severe anemia with less than 7 days stay in the intensive care unit were 89%, 82%, 84.7% and 100% respectively. The length of hospital stay more than 10 days was seen in 58.9%, 71.6%, 63% and 100% in patients with no anemia, mild, moderate and severe anemia. An overall incidence of mortality in anemic patients was 11% while in non anemic patients was 5.3%. Conclusions: The prevalence of anemia was high in the Nepalese patients wi

关键词： Anemia Rheumatic Heart Disease Elective Valve Surgery Blood Transfusion

Hundred plus Minimally Access Cardiac Surgery: Our Experience

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World Journal of Cardiovascular Surgery 2022年第10期12卷 256-263页

作者： Anil Bhattarai Arjun Gurung Prabhat Khakural Ravi Baral Bhagawan Koirala department of cardiothoracic and vascular Surgery Tribhuvan University Manmohan Cardiothoracic Vascular and Transplant Center Kathmandu Nepal department of cardiothoracic & vascular Anesthesiology Tribhuvan University Manmohan Cardiothoracic Vascular and Transplant Center Kathmandu Nepal

Background: Minimally invasive procedures lead to less scarring resulting in better cosmetic outcomes. This has resulted in increased patient interest in such procedures and this has motivated surgeons to pursue newer and improved techniques for Minimally invasive cardiac surgery (MICS). Obviously, with the advent of MICS the techniques to achieve it also needed to be changed and upgraded which includes access for cannulation for cardiopulmonary bypass (CPB). Right internal jugular vein percutaneous cannulation, together with the direct surgical cannulation of femoral vessels with minithoracotomy/ministernotomy proves to be a safe and effective tool in patients with body weight of above 20 kg for minimally access cardiac surgery. We use this technique for Atrial septal defect (ASD) closure, aortic valve replacement (AVR), redo Tricuspid valve replacement (TVR) and mitral valve replacement (MVR). Here, we describe our experience with minimally invasive approach using total peripheral cannulation and an anterior mini-thoracotomy (6 cm or less) incision for ASD closure, AVR, TVR and MVR. Methods: The preoperative variables, intraoperative data and postoperative outcomes of patients undergoing minimally invasive ASD closure, AVR, TVR and MVR with total peripheral cannulation were collected and analyzed. Results: Between May 2014 to May 2019 we performed minimally invasive closure of atrial septal defects, AVR, TVR and MVR with total peripheral cannulation in 103 patients. There were 64 females and 39 males Mean age was 25 years (range 8 - 58 years), Spectrum of procedures include ASD closure in 81 patients (78.6%), AVR via minithoracotomy in 13 patients (12.6%) and AVR via ministernotomy in 3 patients (2.9%), redo TVR in 5 (4.8%), MVR in 1 patient (0.97%). Average cardiopulmonary bypass (CPB) time was 46 minutes (range 22 - 78 min) and average aortic cross-clamp time (AoX) 26 min (range 12 - 45 min) in ASD closure group. In AVR group average CPB time was 91 min (range 7

关键词： Minimal Invasive Cardiac Surgery Cosmetic Outcome Total Peripheral Cannulation

Identification of autophagy signaling network that contributes to stroke in the ischemic rodent brain via gene expression

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Neuroscience Bulletin 2015年第4期31卷 480-490页

作者： Kun Liang Lei Zhu Jinyun Tan Weihao Shi Qing He Bo Yu department of vascular Surgery Huashan HospitalFudan University department of vascular Surgery Shanghai Pudong Hospital

Autophagy plays a vital role in cerebral ischemia and may be a potential target for developing novel therapy for stroke. In this study, we constructed an autophagy-related pathway network by analyzing the genes related to autophagy and ischemic stroke, and the risk genes were screened. Two autophagy-related modules were significantly up-regulated and clustered to influence cerebral ischemia. Besides, three key modular genes （NFKB1, RELA, and STAT3） were revealed. With 5-fold cross validation, the ROC curves of NFKB1, RELA, and STAT3 were 0.8256, 0.8462, and 0.8923. They formed a complex module and competitively mediated the activation of autophagy in cerebral ischemia. In conclusion, a module containing NFKB1, RELA, and STAT3 mediates autophagy, serving as a potential biomarker for the diagnosis and therapy of ischemic stroke.

关键词： cerebral ischemia autophagy functiona module stroke gene expression profile

Randomized Study Comparing Pre-Operative Glycemic Profile in Pediatric Cardiac Surgical Patients Administered Oral Carbohydrate Solution Preoperatively versus Those Kept Fasting

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World Journal of Cardiovascular Diseases 2018年第6期8卷 298-306页

作者： Uma Balasubramaniam Usha Kiran Suruchi Hasija V. Devagourou department of cardiothoracic and vascular Anaesthesia AIIMS New Delhi India department of cardiothoracic and vascular Surgery AIIMS New Delhi India

Objectives: Hypoglycemia is a recognized danger in pediatric patients. Extended period of preoperative fasting in this subset of patients is not well tolerated with metabolic derangements. The oral carbohydrate loading preoperatively can ameliorate many adverse effects. The aim of this study was to compare the glycemic profile in pediatric cardiac surgical patients kept fasting preoperatively with those fed oral clear solutions of carbohydrate half hour prior to induction of anaesthesia. Also we tried to establish a correlation with other factors contributing to preoperative hypoglycemia. Methodology: We planned a randomized controlled study. Group A included patients who were kept fasting according to the ASA guidelines preoperatively and Group B included patients who received 2 ml per kg of body weight of 10% Dextrose water as oral feeds half hour before the expected time of start of anaesthesia. Results: The mean (SD) preoperative BG concentrations were higher in group B (102.5 ±16.97) as compared to group A (64.08 ± 25.37) (p value -0.86 and -0.67) (pvalue Conclusion: Preoperative oral carbohydrate preloading can develop as the easiest and cheapest path to better perioperative blood glucose concentration management in congenital cardiac disease children.

关键词： Congenital Cardiac Disease Hypoglycemia Hypocalcemia Oral Carbohydrate Solution Preoperative Cyanotics Hematocrit

Atrial Septal Defect Closure by Anterior Mini Thoracotomy with Total Peripheral Cannulation: A Step towards Establishing Mini Invasive Cardiac Surgery in a Developing Nation

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World Journal of Cardiovascular Surgery 2020年第10期10卷 192-199页

作者： Prabhat Khakural Ravi Baral Anil Bhattarai Bhagawan Koirala department of cardiothoracic and vascular Surgery Manmohan Cardiothoracic Vascular and Transplant Center Institute of Medicine Maharajgunj Kathmandu Nepal

Background: Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal. Methods: A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. Results: Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97 min ± 12.70 min vs 34.42 min ± 10.42 min and 25.13 min ± 7.82 min vs 19.48