BACKGROUND: Most of the studies conducted have investigated the beneficial effects of ischemic preconditioning on normothermic myocardial ischemia. However, the effect of preconditioning could be attenuated through the use of multidose cold cardioplegia as practiced in contemporary clinical heart surgical procedures. The purpose of this study was to investigate whether preconditioning improves postischemic cardiac function in a model of 25 degrees C moderate hypothermic ischemic heart induced by cold cardioplegia in isolated rat hearts. MATERIAL AND METHOD: The isolated Sprague-Dawley rat hearts were randomly assigned to four groups. All hearts were perfused at 37 degrees C for 20 minutes with Krebs-Henseleit solution before the baseline hemodynamic data were obtained. Group 1 consisted of preconditioned hearts that received 3 minutes of global ischemic preconditioning at 37 degrees C, followed by 5 minutes of reperfusion before 120 minutes of cardioplegic arrest (n=6). Cold (4 degrees C) St. Thomas Hospital cardioplegia solution was infused to induce cardioplegic arrest. Maintaining the heart at 25 degrees C, infusion of the cardioplegia solution was repeated every 20 minutes throughout the 120 minutes of ischemic period. Group 2 consisted of control hearts that underwent no manipulations between the periods of equilibrium and 120 minutes of cardioplegic arrest (n=6). After 2 hours of cardioplegic arrest, Krebs solution was infused and hemodynamic data were obtained for 30 minutes (group 1, 2: cold cardioplegia group). Group 3 received two episodes of ischemic preconditioning before 30 min of 37 degrees C normothermic ischemia and 30 minutes of reperfusion (n=6). Group 4 served as ischemic controls for group 3 (group 3, 4: warm ischemia group). RESULT: Preconditioning did not influence parameters such as left ventricular systolic pressure (LVSP), left ventricular end-diastolic pressure (LVEDP), rate-pressure product (RPP) and left ventricular dp/dt (LV dp/dt) in the cold cardioplegia group. (p=NS) However, preconditioning before warm ischemia attenuated the ischemia induced cardiac dysfunction, improving the LVSP, LVEDP, RPP, and LVdp/dt. Less leakage of CPK and LDH were observed in the ischemic preconditioning group compared to the control group (p<0.05). CONCLUSION: Ischemic preconditioning improved postischemic cardiac function after warm ischemia, but did not protect cold cardioplegic hearts.
Animals ; Blood Pressure ; Cardiac Surgical Procedures ; Heart Arrest, Induced* ; Heart* ; Hemodynamics ; Ischemia ; Ischemic Preconditioning* ; Myocardial Ischemia ; Rats* ; Rats, Sprague-Dawley ; Reperfusion ; Warm Ischemia

BACKGROUND AND OBJECTIVES : In clinical practice, significant recurrence of mitral regurgitation (MR) is observed frequently even after surgical treatment for ischemic MR (IMR). The purpose of this study is to evaluate the recurrence rate of MR and to investigate perioperative predictors for its recurrence following surgery for IMR. SUBJECTS AND METHODS : We retrospectively analyzed 106 patients who underwent surgical management for IMR. Echocardiographic parameters, such as severity of MR, ejection fraction, diastolic left ventricular (LV) dimension, systolic LV dimension, left atrial size, LV sphericity index, mitral valve (MV) tenting area, MV tenting height (TH), tethering distance, MV intraleaflet angle (MVILa), and MV intraleaflet height (MVILh) were measured. RESULTS : Two types of surgery were performed to treat IMR, including valvuloplasty combined with coronary artery bypass graft (CABG)(group A, n=79) and LV volume reduction surgery combined with CABG (group B, n=27). Significant MR was detected echocardiographically 5.4+/-6.7 months after the surgery. The overall recurrence rate of MR was 17% (n=18), and 15.2% (n=12) in group A and 22.2% (n=6) in group B. The preoperative TH and the postoperative MVILh were independent perioperative predictors for the recurrence of significant MR according to multiple logistic regression analysis (p<0.05, respectively). CONCLUSION : The overall postoperative recurrence rate of significant MR after surgical repair is 17% within 6 months. Independent perioperative predictors of recurrent MR after surgery for IMR are the preoperative TH and the postoperative MVILh. For better outcomes in IMR management, those two factors should be considered in the surgical repair of IMR.
Cardiac Surgical Procedures ; Coronary Artery Bypass ; Echocardiography ; Humans ; Logistic Models ; Mitral Valve ; Mitral Valve Insufficiency* ; Recurrence* ; Retrospective Studies ; Transplants

Adenosine ; pharmacology ; Anesthetics, Inhalation ; pharmacology ; Arginine ; pharmacology ; Cardiac Surgical Procedures ; methods ; Heart Arrest, Induced ; Humans ; Ischemic Preconditioning, Myocardial ; Myocardial Reperfusion Injury ; prevention & control ; Nitric Oxide ; physiology

Balloon-tipped, flow-directed (Swan-Ganz) catheters are used commonly for monitoring of cardiac function in patients undergoing cardiac surgical procedures. We report a case of pulmonary hypertension with hypoxemia which may be caused by incorrect positioning of pulmonary artery catheter (PAC) during CABG. Pulmonary arterial pressure (PAP) of 70/40 mmHg which was nearly high as systemic pressure was measured when we tried to wean patient from cardiopulmonary bypass. But, TEE (transesophageal echocardiography) showed nonspecific finding. PAP decreased soon and maintained about 33/16 mmHg for a few minutes. But, the PAP elevated high to 70/40 mmHg again and the arteral oxygen tension (PaO2) decreased to 61.2 mmHg. When we withdrew the PAC to the depth of 35 cm, the PAP and systolic pressure returned to normal range and PaO2 elevaed to 320 mmHg. End tidal CO2 was elevated from 30 mmHg to 35 mmHg.
Anoxia* ; Arterial Pressure ; Blood Pressure ; Cardiac Surgical Procedures ; Cardiopulmonary Bypass ; Catheters* ; Coronary Artery Bypass* ; Coronary Vessels* ; Humans ; Hypertension, Pulmonary* ; Oxygen ; Pulmonary Artery ; Reference Values

OBJECTIVETo evaluate the efficacy and security of one-stop hybrid cardiac surgery for the treatment of adult patients with complex heart disease.

METHODSFrom November 2011 to March 2012, a total of 5 patients [4 male, mean age: (58.8 ± 14.7) years] underwent one-stop hybrid approach in the hybrid operating room. Two patients suffered from multi-coronary lesions, 2 patients were diagnosed with both valvular heart disease and coronary disease, and another 1 patient had valve disease and congenital heart disease (patent ductus arteriosus). Minimally invasive cardiac surgery (coronary artery bypass grafting for the left anterior descending or valvular surgery) and percutaneous intervention were performed in an enhanced operative unit. The efficacy and security of one-stop hybrid cardiac surgery were evaluated after the procedure.

RESULTSThe one-stop hybrid procedure was successful in all patients. Left internal mammary artery grafts were unobstructed. A total of 6 non-left anterior descending coronary lesions were treated by percutaneous coronary intervention and 6 drug-eluting stents were implanted. There was no death, perioperative myocardial infarction, heart failure, prosthetic valve dysfunction, respiratory failure, stroke or repeat surgery during the procedure period. All patients remained free from angina, prosthetic valve dysfunction and patent ductus arteriosus recanalisation during the 3.2 months (rang 1 to 5 months) follow-up period.

CONCLUSIONOne-stop hybrid cardiac surgery provides a reasonable, feasible and safe alternative for treating adult patients with complex heart disease.

Adult ; Aged ; Cardiac Catheterization ; methods ; Cardiac Surgical Procedures ; Coronary Artery Bypass ; methods ; Female ; Heart Diseases ; surgery ; Humans ; Male ; Middle Aged ; Reoperation ; Treatment Outcome

Primary cardiac tumors are extremely rare, occurring in 0.001% to 0.3% of autopsies.1 Most cardiac tumors are metastatic, and they are usually diagnosed in approximately 10% of patients with non-cardiac primary tumors at autopsy.2 3 4 About 75% of primary cardiac tumors are benign and are predominantly myxomas.5 Only 25% of these tumors are malignant, and the most common types in both children and adults, are sarcomas (75%).1 6 7 In a retrospective study done among 255 patients with cardiac tumors in the Philippine Heart Center from 1976 to 2006, the incidence of benign tumors was 91.8% while malignant tumors were reported in 8.2% of cases. Eighty-nine percent of the patients were adults, and 11% were from the pediatric age group.8 As in other similar studies,5 9 the most common cardiac tumors in the Philippine study were myxoma among the adult participants and rhabdomyoma among the pediatric participants.
Heart Neoplasms ; Cardiac Surgical Procedures

Background: Cardiovascular disorders continue to be the most prevalent cause of morbidity and mortality in the Philippines and worldwide. Surgical treatments used to manage cardiovascular disorders (unfortunately) have multiple complications. As part of the health care team, nurses need to develop interventions that are safe, scientifically grounded, and cost-effective in order to counteract these complications. One of the nursing interventions that can be implemented is early ambulation. Aim: To search, appraise, and synthesize the best evidence surrounding early ambulation among cardiac surgery patients. Methods: This study employed an evidence-based review method suggested by Melnyk and Fineout-Overholt (2005). Systematic literature search was done to the following databases: Cochrane, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Joana Briggs Institute (JBI), MEDLINE, National Guideline Clearinghouse (NGC), and Nursing/Academic edition. Post-operative patients who have undergone coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) are included in this study. The final review also included six articles. Results and Discussion Findings show that early ambulation among patients who underwent coronary artery bypass surgery (CABG), percutaneous coronary intervention (PCI), and transfemoral cardiac catheterization (TCC) improves patient care outcomes (i.e., reduce complications such back pain, puncture bleeding, and urinary discomfort, improves general well-being, and decrease health care costs). Parameters for early ambulation (ranges from 3 hours to 24 hours) and late ambulation (ranges from 12 hours to 48 hours) are used in the study reviewed. The non-randomized comparative study found that the complication rate in the early ambulation group is not increased compared to the late ambulation group (test for non-inferiority p= 0.002). Randomized controlled trial found out that early ambulation among cardiac surgery patients could reduce back pain (OR=0.19, 95% CI: 0.08-0.45, p<0.001), decrease urinary discomfort (OR=0.35, 95% CI:0.14-0.90, p=0.03) for very or unbearable urinary discomfort, and general-well being (p=0.0005 for vitality scale and p=0.014 for the total general well-being). Furthermore, early ambulation group reported decrease in hospitalization costs (less charge of $105 or Php 5,040).
Early Ambulation ; Cardiac Surgical Procedures

Since the first report of coronary artery bypass grafting (CABG) in patients with end-stage renal disease in 1974, numerous reports have documented the feasibility of CABG in patients with chronic renal diseases. Patients with chronic renal failure often have comorbid disorders such as hypertension, and diabetes mellitus, each with their own complications and associated impact on both short and long-term survivals. In addition, infection and sepsis have been identified as significant causes of morbidity and mortality in most series of patients with end-stage renal disease undergoing cardiac surgical procedure. As a result of these and other factors such as perioperative volume and electrolyte disturbances, patients with chronic renal failures are at an increased risk of complication and mortality after CABG. We report 3 cases of "Off-pump" CABG in the chronic renal failure patients.
Cardiac Surgical Procedures ; Coronary Artery Bypass* ; Coronary Vessels* ; Diabetes Mellitus ; Humans ; Hypertension ; Kidney Failure, Chronic* ; Mortality ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Sepsis

BACKGROUND: The adequate management of mild to moderate dilatation of the ascending aorta during cardiac operations remains controversial. In this study, we present the short-term outcomes of 90 patients undergoing ascending aortic wrapping with a Dacron graft during other cardiac operations. MATERIALS AND METHODS: From March 2008 to January 2011, 90 consecutive patients underwent treatment for ascending aortic aneurysm using the external wrapping technique during the concomitant procedure. The study group consisted of 49 male and 41 female patients with a mean age of 58.7+/-13 years. The primary cardiac surgical procedures were coronary artery bypass grafting (CABG) in 3, aortic valve replacement in 2, and aortic valvuloplasty in 85 patients (isolated in 62 and combined with CABG or mitral valvuloplasty in 23). The ascending aorta diameter was measured using a computed tomography scan within 4 weeks after surgery, and was compared with the preoperative value. RESULTS: The diameters of the ascending aorta wrapped with the Dacron graft were significantly reduced within a month after surgery from 46.4+/-4.3 mm to 33.0+/-3.5 mm (p<0.05). There was no early mortality or major surgical complication. During the mean follow-up period of 15.4+/-5.2 months, there was only one late death caused by septic multiorgan failure. CONCLUSION: Dacron wrapping of the ascending aorta offers excellent results with very low mortality and morbidity, and it can be regarded as a safe and effective method for the treatment of moderately dilated ascending aorta in selected patients.
Aorta ; Aortic Aneurysm ; Aortic Valve ; Cardiac Surgical Procedures ; Coronary Artery Bypass ; Dilatation ; Female ; Follow-Up Studies ; Humans ; Male ; Polyethylene Terephthalates ; Thoracic Surgery ; Transplants

BACKGROUNDThe temporal response to off-pump anteroapical aneurysm plication has not been well defined. We have evaluated the long-term clinical and functional results of this technique and compared the efficacy with the patch modeling repair.

METHODSFrom March 2005 to May 2010, 163 (115 men and 48 women) consecutive patients were operated on for post-infarction left ventricular aneurysm (LVA), 54 patients underwent patch remodeling (group A) and 109 patients underwent off-pump anteroapical aneurysm plication repair (group B). All patients had simultaneous coronary revascularization, other operative procedures included septoplasty in eight and ablation of ventricular tachycardia in six. Follow-up ranged from 1 to 5 years, short-term and mid-term outcomes, including complications, cardiac function, and mortality, were assessed.

RESULTSEarly mortality was 1.8% for all patients (group A 1 death vs. group B 2 deaths, not significant (NS)). Peri-operative support included intraaortic balloon pumping in 16 (9.8%), (group A 6 patients vs. group B 10 patients, NS) and inotropic drugs in 84 (51.5%), (group A 34 vs. group B 50, NS). During a mean follow-up of (3.7±0.8) years, eight patients died, with four due to cardiac-related causes. No patient required transplantation, and two required use of an implantable cardioverter-defibrillator for ventricular tachycardia. Survival at 1 and 5 years was 95% and 86%, respectively. It did not differ significantly between group A and group B. Functional class improved from 2.90 ± 0.59 to 1.65 ± 0.54 among the mid-term survivors (P < 0.001), with no significant difference between the two groups. Pre-operative risk factors for mortality or poor function were ejection fraction (EF) < 0.35 (OR = 7.9, 95%CI 1.6 - 40.0); congestive heart failure (CHF) (OR = 4.4, 95%CI 1.0 - 19.0); end-systolic volume index (ESVI) > 80 ml/m(2) (OR = 3.7, 95%CI 1.0 - 14.0); and advanced age > 70 years (OR = 2.4, 95%CI 1.0 - 12.0).

CONCLUSIONSThe technique of off-pump anteroapical aneurysm plication associated with coronary grafting can be performed with low operative mortality, providing good symptomatic relief and long-term survival, and similar results can be achieved with patch modeling repair.

Aged ; Cardiac Surgical Procedures ; methods ; Coronary Artery Bypass ; Echocardiography ; Female ; Heart Aneurysm ; surgery ; Humans ; Male ; Middle Aged ; Myocardial Infarction ; surgery ; Retrospective Studies ; Risk Factors