OBJECTIVES

To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality.

Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity.

In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity.

The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.

Repair of complex aortic aneurysms such as those involving the thoracoabdominal and pararenal aorta presents a formidable challenge for surgeons with significant perioperative morbidity and mortality. A hybrid procedure combining renovisceral debranching with endovascular aneurysm exclusion has been developed as an alternative approach for high-risk patients. This paper reports our initial experience with hybrid repair for these complex aortic diseases in three high-risk patients.

Objective: To describe the treatment outcomes of patients who underwent coronary artery bypass grafting (CABG) with vein patch angioplasty with internal mammary artery (IMA) grafting of the diffusely diseased left anterior descending (LAD) coronary artery. Methods: This is a retrospective observational study of 26 patients who have undergone vein patch angioplasty of the LAD coronary artery with IMA grafting in three centers by a single surgeon from January 2012 to August 2017. The demographic profile, intraoperative data, and postoperative outcome (including in-hospital mortality and morbidity, perioperative myocardial infarction, and NYHA functional classification) were recorded. Continuous variables were expressed as means with standard deviation and categorical variables summarized as frequencies and percentages. Student’s t-test was used to compare the preoperative versus postoperative mean NYHA functional class. Results: There were 22 (85%) males and 4 (15%) females with a mean age of 62 years (range: 34 to 82). Twentyfive patients (96%) had a three-vessel disease, and one (4%) had a two-vessel disease. Nine patients (35%) had a preoperative myocardial infarction. The mean cardiopulmonary bypass and aortic-cross clamp times were 156 and 118 minutes, respectively. The mean number of vessels grafted was 4.12. Multiple arterial grafting was used in seven patients (27%). There were two in-hospital mortalities (7.7%) and three morbidities (11.5%), including reoperation for bleeding, acute kidney injury, and leg wound infection. Six patients (23%) developed postoperative atrial fibrillation. No patient developed perioperative myocardial infarction. The mean ICU stay was three days, and the mean hospital stay was 10.27 days. The mean NYHA functional class improved from 2.85 preoperatively to 1.5 postoperatively (p<0.00001). Among patients with improvement, postoperative NYHA improved by two functional classes in 38% and by one functional class in 62%. Conclusion Vein patch angioplasty is a valuable technique for diffuse coronary stenosis of the LAD artery with acceptable early results.
Coronary Artery Bypass

OBJECTIVE

To describe the treatment outcomes of patients who underwent tube pericardiostomy for all etiologies of non-traumatic massive pericardial effusion or tamponade during the COVID-19 pandemic and determine the association between patient profile and treatment outcomes.

Data were obtained from patients with massive pericardial effusion or cardiac tamponade who underwent surgical drainage from January 1, 2020, to September 1, 2022, in the University of the Philippines – Philippine General Hospital (UP-PGH). These patients’ demographic and clinical profiles, and treatment outcomes were evaluated using frequencies and percentages. Chi-squared and Fisher’s tests determined the differences between COVID (+) and (-) groups. Odds Ratio was used to assess the risk of complications and mortality.

The study population comprised 90 patients with a mean age of 45 years. 54.4% were females. Fifteen (16.67%) were COVID-19 (+) and 75 (83.33%) were COVID-19 (-). Most of the patients were of O+ blood type (34.4%), with no smoking history (67.8%) and no COVID-19 vaccination (76.7%). Common comorbidities were cancer (70%), tuberculosis infection (32.2%), and hypertension (25.6%). No significant difference was found between the two study groups. The presentation was subacute (one week to three months) (62.2%), with the most common symptoms of dyspnea (81.1%), orthopnea (61.1%), and cough (52.2%). Tachycardia (80%) and tachypnea (57.8%) were the most common presenting signs. Hypotension was found more frequently among COVID-19 (+) patients (46.7% vs. 12.0%, p = 0,003, 95% CI). Most patients had abnormal WBC, coagulopathy, elevated inflammatory markers, and cardiac biomarkers. Sinus tachycardia, regular sinus rhythm, ST-T wave changes, and low voltage QRS were common ECG findings. The most common chest X-ray results were pleural effusion (80%), pneumonia (71.1%), and enlarged cardiac border (42.2%). Majority of echocardiographic findings were large effusion (>2 cm) (97.8%), RV collapse (40%), and RA collapse (23.3%). An average of 628 ml of pericardial effusion was drained, predominantly serous and exudative. One specimen yielded a positive AFB culture. 6.7% showed carcinoma cells on fluid cytology. The pericardium was normal in 78.9%. 10.0% of the pericardial biopsy specimen had carcinoma, with metastatic cancer being the most common etiology. The most common cancers were lymphoma (22.7%), breast (25.8%), and lung (16.7%). Hospital length of stay was 18 days in COVID-19 (+) patients and 12 days in COVID (-). The complication and in-hospital mortality rate in the COVID-19 (+) compared to the (-) group (86.7% vs. 73.3% and 46.7% vs. 41.3%, respectively) were not statistically significant. The most common complications were respiratory failure (60%), shock (53.3%), and nosocomial pneumonia (40%). There was no association between clinical factors and the risk for complications. Any complication increased the risk for mortality (OR 15.0, 95% CI 3.2-19.7, p=0.002). The presence of hypertension (OR 0.08, 95% CI 0.02 to 0.4, p=0.001) and subacute duration (OR 0.3, 95% CI 0.09 -0.9, p=0.045) decreased the mortality risk.

Profiles were similar in both groups. There was no association between patient profile and complications. Having COVID-19 did not affect patient outcome. The presence of any complication increases the risk of mortality. In-hospital mortality was high at 42.2%.

OBJECTIVE

To describe the treatment outcomes of patients who underwent Percutaneous Transluminal Angioplasty (PTA) for Central Vein Occlusive Disease (CVOD) in end-stage kidney disease and determine the association between patient profile and treatment outcomes.

A single-institution, retrospective review of patients aged 18 and above with end-stage kidney disease who underwent PTA for CVOD in the University of the Philippines - Philippine General Hospital (UP-PGH) from January 1, 2013, to December 31, 2022, was performed. These patients’ demographic and clinical profiles were evaluated using means, frequencies, and percentages. The relationship between patient profile and success of PTA was assessed using Chi-square and Mann-Whitney U tests.

One hundred one patients were included in the study. Eighty-two had a first intervention, and 19 had a recurrent first intervention. The mean age was 49.8 years, with forty-six (45.5%) males and fifty-five (54.5%) females. The most common comorbidity was hypertension (59.4%). This was followed by diabetes (35.6%), chronic glomerulonephritis (18.8%), and NSAID nephropathy (4.9%). Other comorbidities include lupus nephritis, urate nephropathy, and polycystic kidney disease. The interval between symptoms and intervention ranged from two weeks to ninety-six weeks. Eleven patients (10.9%) had an arterio-venous fistula (AVF) before initiating dialysis and did not have a history of dialysis catheter use. Temporary catheters comprise most of the central vein catheters (CVC) (84.2%), while tunneled catheters were a minority (8.9%). The overall central line insertions of one hundred one patients were one hundred fifty-five, most via the right internal jugular vein (86%). There was a total of one hundred twenty-seven lesions seen during venography. Most of these lesions were in the left Innominate vein (38.6%, 39/101) and the right innominate vein (32.7%, 33/101). The most common type of lesion was stenosis (47.5%), followed by abrupt occlusions (31.7%) and tapered occlusions (20.8%). The overall success rate of PTA was 74.2%. In the second intervention for recurrence (n=19), the success rate was 78.9% (15/19). Third-time intervention in three patients was all successful. The success rate in stenotic, tapered, and abrupt lesions were 100%, 85.7%, and 28.1%, respectively. Symptomfree intervals ranged from twelve to one hundred ninetytwo weeks. After a failed intervention, a new fistula or graft was the most common access option (50%). This was followed by central catheter (38.5%), venous bypass (7.7%), and peritoneal dialysis catheter (3.8%). Morbidity was 0.99%. The in-hospital mortality was zero.

Overall PTA success rate for non-recurrent and first operation of recurrent patients with CVOD was high (74%). Stenotic type of lesions were the best vessels to dilate. Failure of PTA was directly related to previous right subclavian catheter insertion, multiple central vein catheter insertions, lesions in the right innominate vein, and an abrupt type of central vein occlusion. The current strategy of PTA for CVOD is both safe and effective. Early AVF creation can prevent patients from requiring multiple catheter insertions and developing CVOD. The right internal jugular vein is the optimal choice for access, while subclavian vein access should be avoided.

Objective: To describe the treatment outcomes of patients who underwent tube thoracostomy for pleural complications in patients with COVID-19 and determine the association between patient profile and treatment outcomes. Methods: A single-institution retrospective review of patients who underwent tube thoracostomy for complications of COVID-19 infection in the University of the Philippines - Philippine General Hospital (UP-PGH) from March 30, 2020, to March 31, 2021, was performed. These patients' demographic and clinical profiles were evaluated using median, frequencies, and percentages. The association between patient profile, and mortality and reintervention rates was assessed using univariable Cox proportional hazards regression analysis. Results: Thirty-four (34) of 3,397 patients (1.00%) admitted for COVID-19 pneumonia underwent tube thoracostomy. Of these, 34, 47.06% were male, 52.94% were female, the median age was 51.5 years old, 85.29% had comorbid conditions, and 29.41% had a previous or ongoing tuberculous infection. The most common indication for tube thoracostomy was pleural effusion (61.76%), followed by pneumothorax (29.41%), and pneumo-hydrothorax (8.82%). The mortality rate was 38.24%, and the reintervention rate was 14.71%. Intubated patients had 14.84 times higher mortality hazards than those on room air. For every unit increase in procalcitonin levels, the mortality hazards were increased by 1.06 times. Conclusion An increasing level of oxygen support on admission and a level of procalcitonin were directly related to mortality risk in COVID-19 patients who underwent tube thoracostomy for pleural complications. There is insufficient evidence to conclude that patient-related, COVID-19 pneumonia-related, and procedure-related factors included in this study were significantly associated with reintervention risk.
COVID-19 ; Pneumonia

Objectives: To describe the treatment outcomes of patients who underwent open repair of infrarenal abdominal aortic aneurysm (AAA) and to determine the risk factors affecting morbidity and mortality. Methods: Data were obtained from patients with infrarenal AAAs who underwent open surgical repair at the University of the Philippines-Philippine General Hospital (UP-PGH) from January 2013 to October 31, 2023. These patients’ demographic and clinical profile, and treatment outcomes were evaluated using frequencies and percentages. Student’s t-test and chi-square test were used for the inferential analysis. Multivariable logistic regression analysis was used to identify factors associated with in-hospital mortality and morbidity. Results: In this study, 131 patients underwent open surgical repair of AAA. 82.4% of the patients were males, and 45.8% were between 61-70 years old. The majority of them had hypertension (81.4%) and were smokers (75%). The mortality rate was 17.6%, while the morbidity rate was 35.9%. For elective operations, the mortality was 8.9%, and for ruptured aneurysms, it was 56.5%. Eleven factors associated with mortality included ruptured aneurysm (OR=11.5, 95%CI=4.1 to 32.2), decreased hemoglobin (OR=1.1, 95%CI=1.05 to 1.2), decreased hematocrit (OR=1.1, 95%CI=1.06 to 1.4), emergency surgery (OR=10.3, 95%CI=2.9 to 36.3), higher volume of blood loss (OR=1.5, 95%CI=1.5 to 1.9), higher red cell transfusion (OR=1.3, 95%CI=1.1-1.5), intraoperative cardiopulmonary (CP) arrest (OR=15.9, 95%CI=1.6 to 159.2), need for multiple inotropes (OR=2.7, 95%CI=1.5-4.8), intraoperative hypotension (OR=3.6, 95%CI=1.4-9.7), juxta-renal location (OR=5.0, 95%CI=1.2 to 10.0), and presence of any complication (OR=5.7, 95%CI=2.1-15.1). Seven factors associated with morbidity included ruptured aneurysm (OR=3.9, 95%CI=1.5 to 9.8), decreased preoperative hemoglobin (OR=1.2, 95%CI=1.1 to 1.4), decreased preoperative hematocrit (OR=1.5, 95%CI=1.1 to 1.7), elevated preoperative creatinine (OR=1.1, 95%CI=1.06 to 1.9), higher intra-operative blood loss (OR=1.4, 95%CI=1.1 to 1.6), higher red cell transfusion (OR=1.6, 95%CI=1.3-2.1), and preexisting chronic renal disease (OR=3.3, 95%CI=1.4 to 7.5). Other preoperative and intraoperative factors did not show a significant association with mortality or morbidity. Conclusion The open repair of an infrarenal AAA is linked to high overall mortality (17.6%) and morbidity (35.9%). The mortality rate for elective repair was 8.9%, but it significantly increased to 56.5% in cases of ruptured aneurysms. Factors with very high Odds Ratio such as emergency surgery, ruptured aneurysm, cardiac arrests during surgery, complex juxtarenal anatomy, and postoperative complications can lead to a high chance of mortality. Healthcare professionals should be vigilant and focus on early detection and repair of abdominal aneurysms to prevent emergency surgery, rupture, and mortality. It is crucial to prevent acute kidney injury, acute respiratory failure, and pneumonia, as these are common complications of open repair.
morbidity ; mortality

Repair of complex aortic aneurysms such as those involving the thoracoabdominal and pararenal aorta presents a formidable challenge for surgeons with significant perioperative morbidity and mortality. A hybrid procedure combining renovisceral debranching with endovascular aneurysm exclusion has been developed as an alternative approach for high-risk patients. This paper reports our initial experience with hybrid repair for these complex aortic diseases in three high-risk patients.
Human ; Male ; Aged: 65-79 yrs old ; Middle Aged: 45-64 yrs old ; aorta ; aortic aneurysm ; endovascular procedures

Objective: To describe the treatment outcomes of patients with chest wall tumors undergoing resection and Birdcage chest wall reconstruction in the local setting. Methods: Data were obtained from 13 patients who underwent chest wall resection and Bird-cage (methylmethacrylate neo-rib, mesh, soft tissue, and skin) reconstruction in the Philippine General Hospital from January 2008 to September 2019. Demographics, operative procedures, 30-day operative morbidity, and mortality were evaluated using means and frequencies. Results: We included 13 (77% female) patients with a mean age of 44.5 years. The most common indication for chest wall resection was recurrent neoplasm (5/13, 38.46%). The most extensive chest wall defect was 600 cm2. The average length of ICU stay was 5.15 days, and two patients had prolonged intubation (>3 days). The graft infection rate was 38%, pneumonia 23%, and the operative mortality rate was zero. Conclusion Bird-cage reconstruction is a safe, reliable, and cheap method of providing rigid chest wall reconstruction for chest wall tumor resection.

Background: PSMA-targeted radiopharmaceuticals have been widely studied for their theragnostic role in prostate cancer and were introduced in the Philippines in 2018. The optimal administered activity of 177Lu-PSMA for targeted endoradiotherapy has not yet been established and is thought to be influenced by several factors, including tumor burden. This study investigates the effect of tumor burden on the normal tissue PSMA uptake among Filipino patients with prostate cancer using its diagnostic counterpart, 68Ga-PSMA I&T Methods: One hundred four patients imaged with 68Ga-PSMA I&T PET/CT in our institution from January 2018 to May 2020 were included. Patients were visually classified into low, medium, and high tumor burden groups. Maximum and mean standardized uptake values (SUVmax and SUVmean) of the lacrimal glands, parotid glands, submandibular glands, kidneys, liver, spleen, and bone were measured and compared among tumor burden groups. Results and Conclusions 68Ga-PSMA I&T uptake in the kidneys, the salivary glands, and the liver, were significantly reduced by approximately 25-50% in patients with high tumor burden. This finding supports the hypothesis that patients with higher tumor load can tolerate higher activity doses of 177Lu-PSMA for endoradiotherapy before developing significant damage to the critical organs. This may serve as a guide towards optimizing and personalizing 177Lu-PSMA I&T administered activity dose for radionuclide therapy
Positron-Emission Tomography ; Prostatic Neoplasms ; Tumor Burden