This study has been conducted in an effort to establish more suitable and accurate scoring model we use in everyday practice. Among the specific outcome prediction models, in 1989 Parsonnet et al elaborated a method of uniform risk stratification for evaluation of the results of cardiac surgery procedures. We have tested two forms of the Parsonnet score, Initial and Modified Parsonnet score, in our patients. In the first half of the year 2007, 145 patients were operated in Sarajevo Heart center. All operated patients in that period, have participated in this study. The overall hospital mortality was 4,13 (6 deaths). This study shows that the initial and modified Parsonnet's scores are predictive for operative mortality in adult cardiac surgery 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 …
Coronary artery aneurysms (CAAs) are rare and their management is controversial. Their incidence varies from 1,5% to 5% of the coronary angiographies, with predilection of the right coronary artery. Unruptured coronary aneurysms are often silent and may remain undiagnosed. The etiology can be either congenital or acquired. We describe a case of a left anterior descending artery (LAD) aneurysm treated with an off-pump surgical revascularization with a LIMA to LAD without exclusion or ligature of the aneurysm.
Our aim was to evaluate risk stratification model, European System for Cardiac Risk Evaluation (logistic EuroSCORE) for patients treated in clinical hospital. EuroSCORE is useful to separate patients into risk groups so that the mortality and morbidity risk can be compared. From 1st January 2006 to 31st July 2006 the total of 124 adults have been operated and were classified according to the EuroSCORE algorithm. We have compared correlation of the predicted mortality and observed mortality (as death within the 30 days following the operation) and frequency of postoperative complications. All patients were divided into three risk groups. The low risk group had 30 patients with 0 death (0%) and 1 morbidity (3,33%). The medium risk group had 59 patients with 0 death (0%) and 4 morbidity (6,77%). The high risk group had 35 patients with 2 death (5,71%) and 5 morbidity (14,28%). Mortality in our clinic is much less than predicted mortality and we can be satisfied with our results. Incidence of complications after cardiac surgery is between 25 and 40% (STS database). Our results are within that range. We recommend logistic version of EuroSCORE as good and simple method to predict postoperative prognosis.
The aim of this study is to compare the effects of colloidal cardioplegia and blood cardioplegia in patients who underwent cardiac surgical procedures with cardiopulmonary bypass, and to evaluate their influence on hemodilution, bleeding and consumption of donor blood products in a retrospective clinical study. 100 male patients who underwent cardiac surgical procedure were divided into two groups: 50 patients were administered intermittent normotherm or mild hypotherm (34 degrees C) Calafiore blood cardioplegia with potassium chloride 14,9%; 50 patients were administered one initial doses of cold Kirsch - solution followed from intermittent cold colloidal cardioplegia using hydroxyethyl starch (HES 450/0,7). Hemoglobin values after the first dose of cardioplegia were significantly lower in the HES-group than in the Calafiore- group). After the first dose of cardioplegia platelets count was lower in the HES-group than in the Calafiore-group. Hemoglobin and hematocrit values 24h postoperative were lower in the HES-group than in the Calafiore-group. There was no difference in chest-drainage bleeding 12h and 24h postoperative between the groups. The consumption of donor erythrocyte concentrate and fresh frozen plasma was significantly higher in the HES-than in the Calafiore- group. The choice of either colloidal or blood cardioplegia does not influence the postoperative chest-drainage bleeding. The results suggest that high molecular colloidal cardioplegia with HES-solution is associated with higher hemodilution during and after cardiopulmonary bypass and significantly increases the consumption of donor blood products.
Background: Minimally invasive coronary artery bypass grafting (MICS CABG) via left anterior thoracotomy has emerged as a less invasive alternative to conventional open sternotomy (OPEN CABG), offering potential benefits in perioperative outcomes and complication rates. Objective. The aim of this study was to compare procedural characteristics, ventilation duration, drainage volumes, and postoperative complications between MICS CABG and OPEN CABG in a single-center cohort in Bosnia and Herzegovina. Methods. This retrospective cross-sectional study included 262 patients who underwent surgical revascularization between January 2019 and June 2023. Results. MICS CABG was associated with a shorter median procedure time (2.5 vs. 3.5 hours, p<0.001) and reduced mechanical ventilation duration (11.0 vs. 14.0 hours, p<0.001). Although ICU stay was similar (3.0 days, p=0.001), total hospitalization was shorter for MICS CABG (6.0 vs. 7.0 days, p<0.001). Postoperative drainage was significantly lower at all measured time points (p<0.05), and transfusion requirements were reduced for red blood cells (0 vs. 2 units, p<0.001), fresh frozen plasma (0 vs. 2.5 units, p<0.001), and platelets (p=0.035). Use of inotropic agents was less frequent in MICS CABG, both at low (50.4% vs. 62.8%, p=0.043) and medium doses (4.0% vs. 16.0%, p=0.001). Wound infections were numerically lower in the MICS group (p=0.437). Conclusions. Compared to open sternotomy, MICS CABG demonstrated significant advantages in operative time, ventilation duration, blood loss, and complication rates, supporting its role as a safe and effective alternative for coronary revascularization.
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