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Sef D, Thet MS, Klokocovnik T, Luthra S. Early and mid-term outcomes after aortic valve replacement using a novel tissue bioprosthesis: a systematic review. Eur J Cardiothorac Surg 2024; 65:ezae045. [PMID: 38331412 DOI: 10.1093/ejcts/ezae045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 01/14/2024] [Accepted: 02/05/2024] [Indexed: 02/10/2024] Open
Abstract
OBJECTIVES While current data show a clear trend towards the use of bioprosthetic valves during aortic valve replacement (AVR), durability of bioprosthetic valves remains the most important concern. We conducted a 1st systematic review of all available evidence that analysed early and mid-term outcomes after AVR using the Inspiris RESILIA™ bioprosthesis. METHODS A systematic literature search was performed to identify all relevant studies evaluating early and mid-term outcomes after AVR using the Inspiris RESILIA bioprosthesis and including at least 20 patients with no restriction on the publication date. Subgroup meta-analysis was performed to compare Inspiris RESILIA and PERIMOUNT Magna Ease bioprosthesis and to pool the early postoperative mortality and stroke rates. RESULTS A total of 416 studies were identified, of which 15 studies met the eligibility criteria. The studies included a total of 3202 patients with an average follow-up of up to 5.3 years. The average age of patients across the studies was 52.2-75.1 years. Isolated AVR was performed in 39.0-86.4% of patients. In-hospital or 30-day postoperative mortality was 0-2.8%. At the mid-term follow-up, freedom from all-cause mortality was up to 85.4%. Among studies with mid-term follow-up, trace/mild paravalvular leak was detected in 0-3.0%, while major paravalvular leak was found only in up to 2.0% of patients. No statistically significant differences in terms of mortality (P = 0.98, odds ratio 1.02, 95% confidence interval 0.36-2.83) and stroke (P = 0.98, odds ratio 1.01, 95% confidence interval 0.38-2.73) between the Inspiris RESILIA bioprosthesis and PERIMOUNT Magna Ease bioprosthesis were observed in the subgroup meta-analysis. CONCLUSIONS Mid-term data on the safety and haemodynamic performance of the novel aortic bioprosthesis are encouraging. Further comparative studies with other bioprostheses and longer follow-up are still required to endorse durability and safety of the novel bioprosthesis.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
| | - Myat Soe Thet
- Faculty of Medicine, Department of Surgery and Cancer, Imperial College London & Imperial College Healthcare NHS Trust, London, UK
| | | | - Suvitesh Luthra
- Department of Cardiac Surgery, Wessex Cardiothoracic Centre, University Hospital of Southampton, Southampton, UK
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Xu A, Wu S, Yang M, Qian Y, Sun H, Witharana P, Kaserer A, Sef D, Shen J, Ma D. Extracorporeal membrane oxygenation (ECMO)-assisted surgery for traumatic bronchial rupture: a report of three cases. J Thorac Dis 2023; 15:7140-7148. [PMID: 38249921 PMCID: PMC10797386 DOI: 10.21037/jtd-23-1783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
Background Traumatic tracheal rupture is a severe closed chest injury that often causes major respiratory and circulatory disturbances requiring emergency surgery. We have found that veno-venous extracorporeal membrane oxygenation (VV-ECMO) employs lung-protective ventilation strategies to facilitate lung rest, aiming to minimize the risk of ventilator-induced lung injury, while ensuring adequate oxygenation. Case Description We presented 3 critically ill patients who presented with traumatic bronchial rupture between 2019 and 2021, and underwent emergency thoracic surgery with the help of VV-ECMO. The ECMO support time, the operative time, the duration of postoperative hospital stay, and the postoperative mechanical ventilation time were collected in this study. All patients were successfully treated and discharged home. The duration of surgery ranged from 135 to 180 min, the duration of ECMO use ranged from 98 to 123 h, the duration of postoperative ventilator use ranged from 5 to 8 days, and the duration of postoperative hospital stay ranged from 14 to 30 days. All 3 patients had good postoperative pulmonary re-expansion, with no residual tracheal or bronchial stenosis, and good physical activity following the surgery. Conclusions We reported successful use of VV-ECMO in critically ill patients with traumatic bronchial rupture presenting in acute respiratory and circulatory failure. Performing emergency surgery with ECMO-assisted support can provide more time to stabilize the patient and ensure the safety of the procedure. However, considering the small sample size of this study, larger cohorts with long-term follow-up data are needed to further evaluate its application.
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Affiliation(s)
- Anyi Xu
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Sikai Wu
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Minghui Yang
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Yicheng Qian
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Hua Sun
- Department of Thoracic Surgery, Taizhou Hospital, Zhejiang University, Taizhou, China
| | - Pasan Witharana
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Alexander Kaserer
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Davorin Sef
- Department of Cardiac Surgery, University Hospitals of Leicester, Leicester, UK
| | - Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
| | - Dehua Ma
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou, China
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Sef D, Luthra S, Predrijevac M, Klokocovnik T, Nguyen TC. Appropriateness of concomitant surgical ablation for atrial fibrillation during redo cardiac surgery. J Thorac Dis 2023; 15:5287-5290. [PMID: 37969257 PMCID: PMC10636443 DOI: 10.21037/jtd-23-1259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/08/2023] [Indexed: 11/17/2023]
Affiliation(s)
- Davorin Sef
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton, UK
| | - Mladen Predrijevac
- Department of Cardiac Surgery, Magdalena – Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | | | - Tom C. Nguyen
- Division of Cardiothoracic Surgery, University of California San Francisco Medical Center, San Francisco, CA, USA
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Masraf H, Sef D, Chin SL, Hunduma G, Trkulja V, Miskolczi S, Velissaris T, Luthra S. Long-Term Survival among Octogenarians Undergoing Aortic Valve Replacement with or without Simultaneous Coronary Artery Bypass Grafting: A 22-Year Tertiary Single-Center Experience. J Clin Med 2023; 12:4841. [PMID: 37510956 PMCID: PMC10381828 DOI: 10.3390/jcm12144841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/12/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The impact of concomitant coronary artery bypass grafting (CABG) on aortic valve replacement (AVR) in octogenarians is still debated. We analyzed the characteristics and long-term survival of octogenarians undergoing isolated AVR and AVR + CABG. METHODS All octogenarians who consecutively underwent AVR with or without concomitant CABG at our tertiary cardiac center between 2000 and 2022 were included. Patients with redo, emergent, or any other concomitant procedures were excluded. The primary endpoints were 30-day and long-term survival. The secondary endpoints were early postoperative outcomes and determinants of long-term survival. Univariable and multivariable logistic regression analyses were performed to identify independent predictors of 30-day mortality, and Cox regression analysis was performed for predictors of adverse long-term survival. RESULTS A total of 1011 patients who underwent AVR (83.0 [81.0-85.0] years, 42.0% males) and 1055 with AVR + CABG (83.0 [81.2-85.4] years, 66.1% males) were included in our study. Survival at 30 days and at 1, 3, and 5 years in the AVR group was 97.9%, 91.5%, 80.5%, and 66.2%, respectively, while in the AVR + CABG group it was 96.2%, 89.6%, 77.7%, and 64.7%, respectively. There was no significant difference in median postoperative survival between the AVR and AVR + CABG groups (7.1 years [IQR: 6.7-7.5] vs. 6.6 years [IQR: 6.3-7.2], respectively, p = 0.21). Significant predictors of adverse long-term survival in the AVR group included age (hazard ratio (HR): 1.09; 95% CI: 1.06-1.12, p < 0.001), previous MI (HR: 2.08; 95% CI: 1.32-3.28, p = 0.002), and chronic kidney disease (HR 2.07; 95% CI: 1.33-3.23, p = 0.001), while in the AVR + CABG group they included age (HR: 1.06; 95% CI: 1.04-1.10, p < 0.001) and diabetes mellitus (HR: 1.48; 95% CI: 1.15-1.89, p = 0.002). Concomitant CABG was not an independent risk factor for adverse long-term survival (HR: 0.89; 95% CI: 0.77-1.02, p = 0.09). CONCLUSIONS The long-term survival of octogenarians who underwent AVR or AVR + CABG was similar and was not affected by adding concomitant CABG. However, octogenarians who underwent concomitant CABG with AVR had significantly higher in-hospital mortality. Each decision should be discussed within the heart team.
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Affiliation(s)
- Hannah Masraf
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Davorin Sef
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Sirr Ling Chin
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Gabriel Hunduma
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | | | - Szabolcs Miskolczi
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Theodore Velissaris
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
| | - Suvitesh Luthra
- Wessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UK
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Thet MS, Verzelloni Sef A, Lees NJ, Sef D. Comment on Oehler et al. Outcome and Midterm Survival after Heart Transplantation Is Independent from Donor Length of Stay in the Intensive Care Unit. Life 2022, 12, 1053. Life (Basel) 2023; 13:1443. [PMID: 37511818 PMCID: PMC10382047 DOI: 10.3390/life13071443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/24/2023] [Accepted: 06/16/2023] [Indexed: 07/30/2023] Open
Abstract
Oehler et al. described an interesting finding, stating that length of stay (LOS) of the donors in the intensive care unit (ICU) did not have an impact on the outcomes and survival of recipients up to 5 years after heart transplantation (HTx) [...].
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Affiliation(s)
- Myat Soe Thet
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London & Imperial College Healthcare NHS Trust, London W2 1NY, UK
| | - Alessandra Verzelloni Sef
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
| | - Nicholas J Lees
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
| | - Davorin Sef
- Royal Brompton and Harefield Hospitals, Harefield Hospital, London UB9 6JH, UK
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Verzelloni Sef A, Sef D, Trkulja V, Marczin N. Current Perspectives and Future Directions in Lung Transplantation. Life (Basel) 2023; 13:1432. [PMID: 37511807 PMCID: PMC10381398 DOI: 10.3390/life13071432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
This Special Issue of Life features compelling original research and reviews related to current trends in lung transplantation (LTx) [...].
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Affiliation(s)
- Alessandra Verzelloni Sef
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
| | - Davorin Sef
- Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
| | | | - Nandor Marczin
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, London UB9 6JH, UK
- Division of Anaesthetics, Pain Medicine and Intensive Care, Department of Surgery and Cancer, Imperial College London, London SW7 2BX, UK
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Sef D, Thet MS, Miskolczi S, Velissaris T, Da Silva R, Luthra S, Turina MI. Perioperative neuromonitoring during thoracoabdominal aortic aneurysm open repair: A systematic review. Eur J Cardiothorac Surg 2023:7180276. [PMID: 37233116 DOI: 10.1093/ejcts/ezad221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/25/2023] [Accepted: 05/25/2023] [Indexed: 05/27/2023] Open
Abstract
OBJECTIVES While open surgical repair remains the gold standard for thoracoabdominal aortic aneurysm (TAAA) treatment, there is still no consensus regarding perioperative neuromonitoring technique for prevention of spinal cord ischaemia (SCI). METHODS In this systematic review, we aimed to explore the effects and practices of neuromonitoring during the open TAAA repair. A systematic literature search in PubMed, Embase via Ovid, Cochrane library and ClinicalTrialsGov until December 2022 was performed. RESULTS A total of 535 studies were identified from the literature search, of which 27 studies including a total of 3130 patients met the eligibility criteria. Most studies (21 out of 27, 78%) investigated the feasibility of motor evoked potentials (MEP), while 15 analysed somatosensory evoked potentials (SSEP) and 2 studies analysed near-infrared spectroscopy (NIRS) during open TAAA repair. CONCLUSIONS Current literature suggest that rates of postoperative SCI can be kept at low levels after open TAAA repair with the adequate precautions and perioperative manoeuvres. Neuromonitoring with MEP provides the surgeon objective criteria to direct selective intercostal reconstruction or other protective anaesthetic and surgical manoeuvres. Simultaneous monitoring of MEP and SSEP is a reliable method that can rapidly detect important findings and direct adequate protective manoeuvres during open TAAA repair.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Myat Soe Thet
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London & Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Szabolcs Miskolczi
- Department of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Theodore Velissaris
- Department of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Ravi Da Silva
- Department of Cardiac Surgery, Royal Papworth Hospital, Cambridge, United Kingdom
| | - Suvitesh Luthra
- Department of Cardiac Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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8
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Dave K, Verzelloni Sef A, Sef D. Evidence for lung transplant in rapidly progressive interstitial lung disease: how to select patients most likely to benefit and future directions. Shanghai Chest 2023; 7:13-13. [DOI: 10.21037/shc-22-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
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9
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Verzelloni Sef A, Jaggar SI, Trkulja V, Alonso-Gonzalez R, Sef D, Turina MI. Factors associated with long-term outcomes in adult congenital heart disease patients with infective endocarditis: A 16-year tertiary single-centre experience. Eur J Cardiothorac Surg 2023:7083437. [PMID: 36946284 DOI: 10.1093/ejcts/ezad105] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/21/2023] [Accepted: 03/21/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES Studies concerning factors associated with long-term outcomes in adult congenital heart disease patients after infective endocarditis are scarce, while infective endocarditis-related mortality in these patients remains a burden. We evaluated the factors associated with long-term survival in adult congenital heart disease patients admitted for infective endocarditis. METHODS We performed a retrospective single-centre study of all adult congenital heart disease patients admitted for infective endocarditis to a tertiary cardiothoracic centre between 1999 and 2015. Underlying adult congenital heart disease, detailed echocardiographic and clinical data, surgical treatment and long-term follow-up were analysed. RESULTS We identified 151 adult congenital heart disease patients admitted due to 176 episodes infective endocarditis with 30-day, 6-month, 1-, 5- and 10-year survival of 95.4%, 92.7%, 92.7%, 84.7% and 75.6%, respectively. In a multivariable analysis, adjusted estimated probability of death was consistently higher after an infective endocarditis episode among patients with complex as compared to simple/moderate adult congenital heart disease: 10.6% vs. 2.4% at 30 days, 15.0% vs. 3.4% at 6 months and 1 year, 30.4% vs. 7.8% at 5 years, and 44.9% vs. 13.1% at 10 years. Risk of death was higher among patients with prosthetic valve in comparison with those without (RR 1.73-1.92). Surgical treatment was required in 76 (43.2%) episodes with 30-day mortality of 3.9%. Risk of death appeared to be lower than in the conservatively treated subgroup (RR 0.71-0.78). CONCLUSIONS We demonstrated satisfactory long-term survival in adult congenital heart disease patients who were treated for infective endocarditis in a tertiary cardiothoracic centre. Early mortality tended to be lower in the surgically treated subgroup. Factors negatively associated with long-term survival were complex adult congenital heart disease and presence of prosthetic valve.
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Affiliation(s)
- Alessandra Verzelloni Sef
- Department of Anaesthesia and Critical Care, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, London, UK
| | - Siân I Jaggar
- Department of Anaesthesia, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Royal Brompton Hospital, London, UK
| | - Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia, EU
| | - Rafael Alonso-Gonzalez
- Division of Cardiology, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Canada
| | - Davorin Sef
- Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital, London, UK
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Robinson NB, Sef D, Gaudino M, Taggart DP. Postcardiac surgery myocardial ischemia: Why, when, and how to intervene. J Thorac Cardiovasc Surg 2023; 165:687-695. [PMID: 34556355 DOI: 10.1016/j.jtcvs.2021.05.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/21/2021] [Accepted: 05/30/2021] [Indexed: 01/18/2023]
Affiliation(s)
- N Bryce Robinson
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Davorin Sef
- Department of Cardiac Surgery, Barts Heart Centre, Barts Health NHS Trust, London, United Kingdom
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - David P Taggart
- Nuffield Department of Surgical Sciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
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Sef D, Trkulja V, Raja SG, Hooper J, Turina MI. Comparing mid-term outcomes of Cox-Maze procedure and pulmonary vein isolation for atrial fibrillation after concomitant mitral valve surgery: A systematic review. J Card Surg 2022; 37:3801-3810. [PMID: 36040710 DOI: 10.1111/jocs.16888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Although concomitant pulmonary vein isolation (PVI) is used more frequently than the Cox-Maze procedure, which is currently the gold standard treatment for atrial fibrillation (AF), data on the comparative effectiveness of the two procedures after concomitant mitral valve (MV) surgery are still limited. OBJECTIVE We conducted a systematic review to identify randomized controlled trials (RCTs) and observational studies comparing the mid-term mortality and recurrence of AF after concomitant Cox-Maze and PVI in patients with AF undergoing MV surgery based on 12-month follow-up. METHODS Medline, EMBASE databases, and the Cochrane Library were searched from 1987 up to March 2022 for studies comparing concomitant Cox-Maze and PVI. Additionally, a meta-analysis of RCTs was performed to compare the mid-term clinical outcomes between these two surgical ablation techniques. RESULTS Three RCTs and three observational studies meeting the inclusion criteria were included in this systematic review with 790 patients in total (532 concomitant Cox-Maze and 258 PVI during MV surgery). Most studies reported that the concomitant Cox-Maze procedure was associated with higher freedom from AF at 12-month follow-up than PVI. Regarding AF recurrence, estimates pooled across the three RCTs indicated large heterogeneity and high uncertainty. In the largest and highest quality RCT, 12-month AF recurrence was higher in the PVI arm (risk ratio = 1.58, 95% CI: 0.91-2.73). In two out of three higher-quality observational studies, 12-month AF recurrence was higher in PVI than in the Cox-Maze arm (estimated adjusted probabilities 11% vs. 8% and 35% vs. 17%, respectively). RCTs demonstrated comparable 12-month mortality between concomitant Cox-Maze and PVI, while observational studies demonstrated the survival benefit of Cox-Maze. CONCLUSIONS Concomitant Cox-Maze in AF patients undergoing MV surgery is associated with better mid-term freedom from AF when compared to PVI with comparable mid-term survival. Large observational studies suggest that there might be a mid-term survival benefit among patients after concomitant Cox-Maze. Further large RCTs with longer standardized follow-up are required to clarify the benefits of concomitant Cox-Maze in AF patients during MV surgery.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK
| | - Joanne Hooper
- Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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12
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Sinning JM, Ibrahim K, Schröder J, Sef D, Burzotta F. Optimal bail-out and complication management strategies in protected high-risk percutaneous coronary intervention with the Impella. Eur Heart J Suppl 2022; 24:J37-J42. [PMID: 36518892 PMCID: PMC9730790 DOI: 10.1093/eurheartjsupp/suac064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Despite the routine use of percutaneous mechanical circulatory support (pMCS) with the Impella heart pump, vascular and bleeding complications may occur during removal with or without pre-closure. To safely close the large-bore access (LBA), post-hoc selection of the appropriate treatment of vascular complications is critical to patient recovery and survival. Femoral artery access is typically utilized for LBA, and percutaneous axillary artery access is a common alternative, especially in the instance of severe peripheral artery disease. Optimization of patient outcomes and efficiency of pMCS can be achieved with adequate arterial access using state-of-the-art techniques. Impella removal techniques with or without pre-closure will be addressed as well as the management of large-bore femoral access complications. In addition, treatment strategies to manage patient deterioration during a protected high-risk percutaneous coronary intervention will be provided.
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Affiliation(s)
- Jan-Malte Sinning
- Department of Cardiology, St Vinzenz Hospital Cologne, Cologne, Germany
| | - Karim Ibrahim
- Department of Cardiology, Technische Universität Dresden (Campus Chemnitz), Klinikum Chemnitz, Chemnitz, Germany
| | - Jörg Schröder
- Department of Cardiology, University Hospital RWTH Aachen, Aachen, Germany
| | - Davorin Sef
- Department of Cardiac Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust Harefield Hospital, Harefield, UK
| | - Francesco Burzotta
- UOC Interventistica Cardiologica e Diagnostica Invasiva, Fondazione Policlinico Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Sef D, Kovacevic M, Jernej B, Novacic K, Slavica M, Petrak J, Medved I, Milosevic M. Immunohistochemical analysis of MMP-9 and COX-2 expression in carotid atherosclerotic plaques among patients undergoing carotid endarterectomy: A prospective study. J Stroke Cerebrovasc Dis 2022; 31:106731. [PMID: 36075131 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 08/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Matrix metalloproteinase-9 protein (MMP-9) and cyclooxygenase-2 (COX-2) proteins may have a role in remodelling of atherosclerotic plaques. We analysed and compared the radiological, histological and immunohistochemical characteristics of carotid atherosclerotic plaques between symptomatic and asymptomatic patients who underwent carotid endarterectomy (CEA). METHODS This prospective single-blinded study included 31 patients (70 [64-75] years, 58% males, 42% symptomatic) who underwent CEA and a total of 155 carotid plaque sections that were analysed. Preoperative assessment and multimodality diagnostic imaging with magnetic resonance imaging (MRI) or computed tomography angiography (CTA), histological and immunohistochemical analyses of carotid plaques including the expression of MMP-9 and COX-2 proteins were performed. RESULTS Symptomatic and asymptomatic patients did not significantly differ in respect to preoperative characteristics. Unstable plaques were detected in 12/13 (92.3%, p = 0.020) symptomatic patients using MRI or CTA. There was no perioperative mortality and perioperative outcomes were comparable in both groups. A significantly higher expression of MMP-9 in macrophages was observed among symptomatic patients (p = 0.020). ROC curve analysis showed statistically significant associations of both the higher intensity of COX-2 staining in CD68 PG-M1 positive macrophages (area under the curve [AUC]=0.701, p = 0.014) and higher MVD (AUC=0.821, p < 0.001) within the plaque with cerebrovascular symptoms. The expression of COX-2 and the intensity of COX-2 staining in macrophages within the unstable carotid plaques detected by preoperative MRI or CTA were significantly higher (76.1% vs. 40.0%, p = 0.038; 76.2% vs. 30.0%, p = 0.01, respectively). CONCLUSIONS Advanced non-invasive multimodality diagnostic imaging including MRI or CTA is reliable in differentiating unstable from stable carotid plaques. High expression of MMP-9 and COX-2 in macrophages within the symptomatic plaque is associated with increased risk of cerebrovascular complications. TRIAL REGISTRATION This study has been registered at the ISRCTN registry (ID ISRCTN46536832), isrctn.org Identifier: https://www.isrctn.com/ISRCTN46536832.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy's and St. Thomas' NHS Foundation Trust, London, UK.
| | - Miljenko Kovacevic
- Department of Vascular Surgery, University Hospital Centre Rijeka, Rijeka, Croatia, EU
| | - Bojan Jernej
- Polyclinic for Radiology and Neurology "Dijagnostika 2000", Zagreb, Croatia, EU
| | - Karlo Novacic
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Zagreb, Croatia, EU
| | - Marko Slavica
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, Zagreb, Croatia, EU
| | - Jelka Petrak
- University of Zagreb, School of Medicine, Zagreb, Croatia, EU
| | - Igor Medved
- Department of Cardiac Surgery, University Hospital Centre Rijeka, Rijeka, Croatia, EU
| | - Milan Milosevic
- University of Zagreb, School of Medicine, Zagreb, Croatia, EU; Andrija Stampar School of Public Health, Zagreb, Croatia, EU
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14
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Boldyrev S, Finsterer J, Stöllberger C, Suslova V, Barbukhatty K, Sef D. Aortic root replacement for aortic root aneurysm with severe aortic regurgitation and incidentally detected left ventricular hyper-trabeculation/noncompaction. Indian J Thorac Cardiovasc Surg 2022; 38:533-536. [PMID: 36050986 PMCID: PMC9424400 DOI: 10.1007/s12055-022-01371-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 04/05/2022] [Accepted: 04/26/2022] [Indexed: 11/28/2022] Open
Abstract
A 54-year-old male with severe aortic regurgitation (AR), aortic root aneurysm, left ventricular hyper-trabeculation/noncompaction (LVHT) and systolic dysfunction with a left ventricular ejection fraction (LVEF) of 52% underwent successful aortic root replacement. Intraoperative video-endoscopy confirmed LVHT. At 3-year follow-up, he remains in an excellent clinical condition and echocardiography shows an improvement of the systolic function, LVHT and LVEF of 66%. Timely surgical correction of severe AR may also lead to improvement of systolic function in a patient with LVHT.
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Affiliation(s)
- Sergey Boldyrev
- Scientific Research Institute – Ochapovsky Regional Clinical Hospital #1, 140 Rossiyskaya St, Krasnodar, 350086 Russia
- Kuban State Medical University, 140 Rossiyskaya St, Krasnodar, 350086 Russia
| | | | | | - Valentina Suslova
- Scientific Research Institute – Ochapovsky Regional Clinical Hospital #1, 140 Rossiyskaya St, Krasnodar, 350086 Russia
| | - Kirill Barbukhatty
- Scientific Research Institute – Ochapovsky Regional Clinical Hospital #1, 140 Rossiyskaya St, Krasnodar, 350086 Russia
- Kuban State Medical University, 140 Rossiyskaya St, Krasnodar, 350086 Russia
| | - Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy’s and St, Thomas’ NHS Foundation Trust, Hill End Rd, Harefield, London, UB96JH UK
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15
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Sef D, Krajnc M, Klokocovnik T. Reply to Özahn et al.: "Challenges in sutureless aortic valve implantation with minimal invasive technique". J Card Surg 2022; 37:3457-3458. [PMID: 35801500 DOI: 10.1111/jocs.16757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery and Transplant Unit, Royal Brompton and Harefield Hospitals, Harefield Hospital, London, UK
| | - Martina Krajnc
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Tomislav Klokocovnik
- Department of Cardiac Surgery and Transplant Unit, Royal Brompton and Harefield Hospitals, Harefield Hospital, London, UK
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16
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Thet MS, Verzelloni Sef A, Sef D. Can adequate hemodynamic management of brain-dead donors improve donor organ procurement? World J Transplant 2022; 12:79-82. [PMID: 35633852 PMCID: PMC9048440 DOI: 10.5500/wjt.v12.i4.79] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/19/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
There is increasing evidence that adequate donor management with a goal of optimization of organ function is essential to maximize the number of organs that can be procured. Therefore, identification of the cause of hemodynamic instability is crucial in order to direct the right therapy. Several donor management goals for better hemodynamic management including serial echocardiography can guide hemodynamic management in potential donors to increase both number and quality of donor hearts.
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Affiliation(s)
- Myat Soe Thet
- Department of Cardiac Surgery, St Bartholomew’s Hospital, London EC1A 7BE, United Kingdom
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London & Imperial College Healthcare NHS Trust, London W2 1NY, United Kingdom
| | - Alessandra Verzelloni Sef
- Department of Anaesthesia and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, London UB9 6JH, United Kingdom
| | - Davorin Sef
- Department of Cardiothoracic Surgery and Transplant Unit, Harefield Hospital, Royal Brompton and Harefield Hospitals, Part of Guy’s and St Thomas’ NHS Foundation Trust, London UB9 6JH, United Kingdom
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17
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Sef D, Bahrami T, Raja SG, Klokocovnik T. Current trends in minimally invasive valve‐sparing aortic root replacement—Best available evidence. J Card Surg 2022; 37:1684-1690. [PMID: 35348237 DOI: 10.1111/jocs.16453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/20/2022] [Accepted: 03/05/2022] [Indexed: 01/25/2023]
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Toufan Bahrami
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Shahzad G. Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield Hospitals Part of Guy's and St. Thomas' NHS Foundation Trust London UK
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery University Hospital Center Ljubljana Ljubljana Slovenia
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18
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Sef D, Verzelloni Sef A, Trkulja V, Raj B, Lees NJ, Walker C, Mitchell J, Petrou M, De Robertis F, Stock U, McGovern I. Midterm outcomes of venovenous extracorporeal membrane oxygenation as a bridge to lung transplantation: Comparison with nonbridged recipients. J Card Surg 2022; 37:747-759. [PMID: 35060184 DOI: 10.1111/jocs.16253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/28/2021] [Accepted: 12/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Alessandra Verzelloni Sef
- Department of Anesthesia and Critical Care Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Vladimir Trkulja
- Department of Pharmacology Zagreb University School of Medicine Zagreb Croatia
| | - Binu Raj
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Nicholas J. Lees
- Department of Anesthesia and Critical Care Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Christopher Walker
- Department of Anesthesia and Critical Care Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Jerry Mitchell
- Department of Anesthesia and Critical Care Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Mario Petrou
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
| | - Ian McGovern
- Department of Anesthesia and Critical Care Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, Harefield Hospital London UK
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19
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Sef D, Milosevic M, Ostric M, Mestrovic T, Jernej B, Kovacic S, Kovacevic M, Skrtic A, Vidjak V. The role of magnetic resonance imaging and the expression of MMP-9 protein in the analysis of carotid atherosclerotic plaques in patients undergoing carotid endarterectomy: a prospective pilot study. Rev Cardiovasc Med 2021; 22:1611-1620. [PMID: 34957802 DOI: 10.31083/j.rcm2204167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 09/01/2023] Open
Abstract
Components of carotid atherosclerotic plaque can be analysed preoperatively by non-invasive advanced imaging modalities such as magnetic resonance imaging (MRI). The expression of matrix metalloproteinase-9 protein (MMP-9), which has a potential role in remodelling of atherosclerotic plaques, can be analysed immunohistochemically. The aim of the present prospective pilot study is to analyse histological characteristics and expression of MMP-9 in carotid plaques of patients undergoing carotid endarterectomy (CEA) and to investigate the correlation with preoperative clinical symptoms and MRI features. Preoperative clinical assessment, MRI imaging, postoperative histological and immunohistochemical analyses were performed. Fifteen patients with symptomatic (7/15; 47%) and asymptomatic carotid artery stenosis undergoing CEA were included. Among symptomatic patients, 5 (71%) had recent stroke and 2 (29%) had recent transient ischaemic attack with a median timing of 6 weeks (IQR: 1, 18) before the surgery. Both groups did not significantly differ in respect to preoperative characteristics. Prevalence of unstable plaque was higher in symptomatic than asymptomatic patients, although it was not significant (63% vs. 37%, p = 0.077). The expression of MMP-9 in CD68 cells within the plaque by semiquantitative analysis was found to be significantly higher in symptomatic as compared to asymptomatic patients (86% vs. 25% with the highest expression, p = 0.014). The average microvascular density was found to be higher and lipid core area larger among both symptomatic patients and unstable carotid plaque specimens, although this did not reach statistical significance (p = 0.064 and p = 0.132, p = 0.360 and p = 0.569, respectively). Our results demonstrate that MRI is reliable in classifying carotid lesions and differentiating unstable from stable plaques. We have also shown that the expression of MMP-9 is significantly higher among symptomatic patients undergoing CEA.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, The Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, EC1A 7BE London, UK
| | - Milan Milosevic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Andrija Stampar School of Public Health, 10000 Zagreb, Croatia
| | - Marin Ostric
- Department of Cardiac Surgery, University Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Tomislav Mestrovic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Vascular Surgery, University Hospital Centre Zagreb, 10000 Zagreb, Croatia
| | - Bojan Jernej
- Polyclinic for Radiology and Neurology "Dijagnostika 2000", 10000 Zagreb, Croatia
| | - Slavica Kovacic
- Department of Radiology, University Hospital Centre Rijeka, 51000 Rijeka, Croatia
- School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
| | - Miljenko Kovacevic
- School of Medicine, University of Rijeka, 51000 Rijeka, Croatia
- Department of Vascular Surgery, University Hospital Centre Rijeka, 51000 Rijeka, Croatia
| | - Anita Skrtic
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Pathology, University Hospital Merkur, 10000 Zagreb, Croatia
| | - Vinko Vidjak
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, 10000 Zagreb, Croatia
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20
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Potapov EV, Politis N, Karck M, Weyand M, Tandler R, Walther T, Emrich F, Reichenspurrner H, Bernhardt A, Barten MJ, Svenarud P, Gummert J, Sef D, Doenst T, Tsyganenko D, Loforte A, Schoenrath F, Falk V. Results from a multicentre evaluation of plug use for left ventricular assist device explantation. Interact Cardiovasc Thorac Surg 2021; 34:683-690. [PMID: 34888681 PMCID: PMC9026212 DOI: 10.1093/icvts/ivab344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/21/2021] [Accepted: 10/29/2021] [Indexed: 12/01/2022] Open
Affiliation(s)
- Evgenij V Potapov
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | | | - Matthias Karck
- Department of Cardiac Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Weyand
- Department of Cardiac Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - René Tandler
- Department of Cardiac Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Thomas Walther
- Department of Cardiac Surgery, Johann-Wolfgang-Goethe University, Frankfurt, Germany
| | - Fabian Emrich
- Department of Cardiac Surgery, Johann-Wolfgang-Goethe University, Frankfurt, Germany
| | - Hermann Reichenspurrner
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Alexander Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Markus J Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Peter Svenarud
- Department of Cardiothoracic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Jan Gummert
- Department of Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW Ruhr-University of Bochum, Bad Oeynhausen, Germany
| | - Davorin Sef
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
| | - Dmytro Tsyganenko
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Antonio Loforte
- Division of Cardiac Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, S. Orsola University Hospital, Bologna, Italy
| | - Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.,Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Cardiovascular Surgery, Berlin, Germany.,Department of Health Sciences and Technology, Eidgenössiche Technische Hochschule Zürich, Translational Cardiovascular Technology, Zurich, Switzerland
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21
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Sef D, Brown S, Haslam E, Rajakaruna C, McAloon C. 1313 Unusual Supraannular Aortic Root Intimal Tear in a Patient with Severe Aortic Regurgitation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
We present an extremely rare case of occult supraannular aortic root intimal tear in a patient presenting with acute severe aortic regurgitation (AR) and a previously undiagnosed bicuspid aortic valve.
A 41-year-old Africo-Carribean female presented to the emergency department with acute pulmonary oedema and increasing dyspnea on exertion. She had been treated empirically with antibiotics for a chest infection. Initial concerns were either aortic dissection or infective endocarditis. Transthoracic echocardiography (TTE) demonstrated a normal size left ventricle with hyperdynamic systolic function and severe AR. The patient was transferred to a tertiary cardiothoracic surgical centre for urgent surgical treatment in view of haemodynamic instability and acute AR. A gated computed tomography aortogram identified pulmonary oedema with an asymmetrically dilated aortic root (maximal diameter 45 mm).
Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and prompted Bentall procedure with mechanical aortic valve. After median sternotomy and initiation of cardiopulmonary bypass, a supraannular aortic intimal tear starting from the right coronary cusp/noncoronary cusp commissure was found with no extension into the aorta. The aortic valve was bicuspid and severe AR not amenable to repair was found. Bentall procedure was performed using the 23/26mm Carbomedics Carbo Seal Valsalva composite graft (Sulzer Carbomedics Inc, Austin, TX, USA).
The patient was discharged on the 7th postoperative day in sinus rhythm. At 30-day clinical follow-up she was symptom free with a satisfactory TTE.
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Affiliation(s)
- D Sef
- Barts Health NHS Trust, London, United Kingdom
| | - S Brown
- Gloucester Royal Hospital, Gloucester, United Kingdom
| | - E Haslam
- Gloucester Royal Hospital, Gloucester, United Kingdom
| | - C Rajakaruna
- Bristol Royal Infirmary, Bristol, United Kingdom
| | - C McAloon
- Gloucester Royal Hospital, Gloucester, United Kingdom
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22
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Verzelloni Sef A, Caliandro F, Sef D, Raja SG. The use of point-of-care testing in detecting platelet function recovery in a patient treated with prasugrel undergoing urgent surgical revascularization. J Card Surg 2021; 36:4801-4804. [PMID: 34580922 DOI: 10.1111/jocs.16035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
A recent administration of potent P2Y12 receptor inhibitor such as prasugrel in patients undergoing cardiac surgery remains a dilemma and little is known about its impact on platelet function recovery. Guidelines recommend discontinuation of prasugrel 7 days before surgery to reduce the risk of surgery-related bleeding. Patients at risk may benefit from preoperative platelet function testing to guide individualized preoperative waiting time. We present a rare case of complete function recovery in a patient treated with prasugrel revealed by preoperative platelet function monitoring before urgent coronary artery bypass surgery (CABG). A complete platelet function recovery was revealed by platelet function testing after discontinuation of prasugrel for four days and patient underwent urgent CABG without increased risk of postoperative bleeding. Our case with a review of literature emphasized that the decision to proceed with urgent CABG in a patient recently treated with prasugrel should be based on a personalized risk assessment and might be supported by preoperative platelet function monitoring to shorten the waiting time.
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Affiliation(s)
- Alessandra Verzelloni Sef
- Department of Anesthesia and Critical Care, Royal Brompton & Harefield Hospitals, Harefield Hospital, London, UK
| | - Francesca Caliandro
- Department of Anesthesia and Critical Care, Royal Brompton & Harefield Hospitals, Harefield Hospital, London, UK
| | - Davorin Sef
- Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, Harefield Hospital, London, UK
| | - Shahzad G Raja
- Department of Cardiac Surgery, Royal Brompton & Harefield Hospitals, Harefield Hospital, London, UK
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23
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Verzelloni Sef A, Sef D, Trkulja V, Raj B, Lees NJ, Walker C, McGovern I, Mitchell J, De Robertis F, Stock U. Postoperative acute kidney injury and renal replacement therapy after DCD lung transplantation. Clin Transplant 2021; 36:e14468. [PMID: 34418160 DOI: 10.1111/ctr.14468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 07/09/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Abstract
Acute kidney injury (AKI) after lung transplantation (LTx) is a common complication. We aimed to assess whether donation after circulatory death (DCD) is associated with an increased risk of AKI and renal replacement therapy (RRT) in the early postoperative period compared to the donation after brain death (DBD). Retrospective data on a cohort (N = 95) of LTx patients (DCD n = 17, DBD n = 78) characterized by no use of ex-vivo lung perfusion were analyzed for the incidence of AKI within 30 postoperative days and incidence of RRT within 7 and 30 days. After optimal full matching, an imbalance remained between the DCD and DBD patients in respect to intraoperative use of cardiopulmonary bypass (CPB). Therefore, a further subset (n = 77) was defined that excluded CPB patients, and matching was repeated (DCD n = 13 vs. DBD n = 63) resulting in a fair balance on a range of preoperative characteristics and intraoperative use of ECMO. In both matched subsets, DCD was associated with around twice higher risk of AKI and RRT within 7 and 30 postoperative days. In conclusion, data suggest that DCD could be associated with worse early renal outcomes in a subset of LTx patients and justify further studies on the topic in order to refine further renal care pathways perioperatively.
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Affiliation(s)
- Alessandra Verzelloni Sef
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Davorin Sef
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia
| | - Binu Raj
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Nicholas James Lees
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher Walker
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ian McGovern
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jerry Mitchell
- Department of Anesthesia and Critical Care, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Harefield Hospital, Royal Brompton & Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, UK
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24
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Mohite PN, Sef D, Umakumar K, Maunz O, Smail H, Stock U. Utilization of Paragonix SherpaPak for human donor heart preservation. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34143579 DOI: 10.1510/mmcts.2021.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A heart transplant is the gold standard treatment for end stage heart failure. Preservation of the donor heart during its transfer from the hospital of the donor to that of the recipient has a significant impact on the outcome of the transplant procedure. Icebox storage is a conventional method utilized for this purpose that may not provide uniform cooling of the donor heart and does not allow monitoring of the temperature of the donor heart during preservation. The Paragonix SherpaPak Cardiac Transport System offers uniform cooling by suspending the donor heart in a preservation solution and provides continuous temperature monitoring.
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Affiliation(s)
- Prashant N Mohite
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Davorin Sef
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Kabeer Umakumar
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Olaf Maunz
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Hassiba Smail
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
| | - Ulric Stock
- Royal Brompton and Harefield NHS Foundation Trust Hill End Road, Harefield, Uxbridge, London, UB9 6JH
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Sef D, Brown S, Jarral OA, Hussain A, Haslam E, Rajakaruna C, McAloon CJ. Subtle aortic dissection in a patient with severe aortic regurgitation and undiagnosed bicuspid aortic valve: A case report with a literature review. J Card Surg 2021; 36:3417-3420. [PMID: 34075627 DOI: 10.1111/jocs.15714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 05/18/2021] [Accepted: 05/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY A subtle aortic dissection can be challenging to detect despite the availability of multiple diagnostic modalities. Whilst rare, the inability to detect this variant of aortic dissection can lead to a dismal prognosis. We present an extremely rare case of a subtle aortic dissection with supra-annular aortic root intimal tear and acute severe aortic regurgitation in a patient with a bicuspid aortic valve. METHODS Case report and literature review conserning subtle aortic dissection is provided. RESULTS Initial concerns were either aortic dissection or infective endocarditis. Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and a Bentall procedure with a mechanical aortic valve was performed. CONCLUSIONS Our case along with the review of current literature emphasizes that current imaging techniques may be inadequate for diagnosis of this rare variant of aortic dissection.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, The Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Stewart Brown
- Department of Cardiology, Gloucester Royal Hospital, Gloucester, UK
| | - Omar A Jarral
- Department of Cardiac Surgery, The Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Azhar Hussain
- Department of Cardiac Surgery, The Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Elizabeth Haslam
- Department of Cardiology, Gloucester Royal Hospital, Gloucester, UK
| | - Cha Rajakaruna
- Department of Cardiac Surgery, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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Sef AV, Sef D, Mohite P, Saez DG, Trkulja V, Raj B, Reed A, Doce AH, Lees N, Mahesh B, De Robertis F, McGovern I, Simon A, Stock U. Early Results after Lung Transplantation in Patients Bridged with Extracorporeal Life Support: Experience from a 7-year Period. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Potapov E, Politis N, Rieger S, Karck M, Weyand M, Walther T, Emrich F, Reichenspurrner H, Bernhadt A, Barten M, Svenarud P, Gummert J, Simon A, Sef D, Doenst T, Tsyganenko D, Falk V. Results of Multicenter Evaluation of Plug Use for LVAD Explantation. J Heart Lung Transplant 2021. [DOI: 10.1016/j.healun.2021.01.1176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sef D, Manghat NE, Dimagli A, Benedetto U. Giant aortic aspergilloma in a patient with previous aortic graft implantation. Eur Heart J Case Rep 2021; 5:ytab036. [PMID: 33629025 PMCID: PMC7889714 DOI: 10.1093/ehjcr/ytab036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 12/29/2020] [Accepted: 01/20/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Office Room 84, Level 7, Upper Maudlin Street, Bristol BS28HW, UK
| | - Nathan E Manghat
- Department of Clinical Radiology, Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Office Room 84, Level 7, Upper Maudlin Street, Bristol BS28HW, UK
| | - Arnaldo Dimagli
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Office Room 84, Level 7, Upper Maudlin Street, Bristol BS28HW, UK
| | - Umberto Benedetto
- Department of Cardiac Surgery, Bristol Heart Institute, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Office Room 84, Level 7, Upper Maudlin Street, Bristol BS28HW, UK
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29
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Sef D, Krajnc M, Klokocovnik T. Cover Image: Volume 36 Issue 2. J Card Surg 2021. [DOI: 10.1111/jocs.15371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust Harefield Hospital London UK
| | - Martina Krajnc
- Department of Cardiovascular Surgery University Hospital Centre Ljubljana Ljubljana Slovenia
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery University Hospital Centre Ljubljana Ljubljana Slovenia
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Sef D, Kabir T, Lees NJ, Stock U. Valvular complications following the Impella device implantation. J Card Surg 2021; 36:1062-1066. [PMID: 33410194 DOI: 10.1111/jocs.15303] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/21/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite clear clinical benefits, there is limited evidence regarding possible complications of the novel mechanical support device Impella. Aortic and mitral valve regurgitation or injury are rare but potential complications following implantation of the Impella device. METHODS To evaluate valvular complications after the Impella device implantation, we have performed a comprehensive search of literature on multiple sites on this topic. RESULTS AND CONCLUSION Ten case reports and one observational retrospective study were identified, with a total number of 19 patients identified. This article aims to draw attention to potential periprocedural complications relating to the Impella, in particular iatrogenic aortic and mitral valve injuries. Moreover, we have summarized our recommendations emphasizing the need for careful management and meticulous follow-up of these patients to avoid such potentially devastating complications.
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Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Tito Kabir
- Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Nicholas James Lees
- Department of Anaesthesia and Critical Care, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
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Sef D, Raja SG. Bilateral internal thoracic artery use in coronary artery bypass grafting in the post-ART era - Perspective. Int J Surg 2020; 86:1-4. [PMID: 33388437 DOI: 10.1016/j.ijsu.2020.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
There is still lack of convincing evidence about the superiority of bilateral internal thoracic artery (BITA) use in coronary artery bypass grafting (CABG) and BITA grafts continue to be underutilized. Arterial Revascularization Trial (ART) did not demonstrate the superiority of BITA versus single ITA grafting after 10 years. We have reviewed the most recent literature, assessed the current status as well as indications of BITA grafting in the post-ART era. We believe that BITA grafting is not appropriate for all patients especially in light of the findings of ART. However, the use of BITA is justified in patients of younger age and those without comorbidities (poorly controlled diabetes, obesity, chronic obstructive pulmonary disease, previous mediastinal irradiation, long-term steroid use, elderly women). Further prospective randomized studies with long-term follow-up are needed to validate the benefits of BITA grafting.
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Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom.
| | - Shahzad G Raja
- Department of Cardiac Surgery, Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
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Sef D, Krajnc M, Klokocovnik T. Minimally invasive aortic valve replacement with sutureless bioprosthesis through right minithoracotomy with completely central cannulation-Early results in 203 patients. J Card Surg 2020; 36:558-564. [PMID: 33314301 DOI: 10.1111/jocs.15257] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/18/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Minimally invasive aortic valve replacement (mini-AVR) might improve clinical outcomes, particularly in high-risk and elderly patients. Sutureless/rapid deployment bioprosthesis can offer advantage of decreasing the cross-clamp time (XCT) and easing the procedure. Our aim was to evaluate the safety and perioperative outcomes of mini-AVR using sutureless bioprothesis via the right minithoracotomy approach with our modified technique of central cannulation. METHODS We performed a single-center retrospective analysis of 203 patients consecutively undergoing isolated AVR between March 2016 and June 2018 with the right minithoracotomy approach and our modified technique of central cannulation. Aortic valve diseases were stenosis (89.9%), regurgitation (1.6%), and mixed valve disease (8.5%). Patients with concomitant procedures were excluded. Primary endpoints were 30-day and 4-month mortality. RESULTS Mean age was 76 ± 6.2 years, 63 (31%) patients were 80 years or older. Cardiopulmonary bypass and XCT were 60.5 (39-153) and 35 (24-76) min, respectively. Thirty-day and 4-month mortality were 1% (two patients). We have observed minor paravalvular leak (PVL) which occurred in seven patients (3.4%), and no moderate/severe PVL was found perioperatively. One patient developed moderate/severe PVL during the 4-month follow-up. There was no structural valve degeneration. Two (1%) patients needed conversion to full sternotomy, and two (1%) patients to ministernotomy. CONCLUSIONS Mini-AVR via the right minithoracotomy approach with central cannulation is an effective and safe procedure and demonstrates excellent early clinical outcomes. This approach can be particularly valuable in higher risk and elderly patients.
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Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Martina Krajnc
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
| | - Tomislav Klokocovnik
- Department of Cardiovascular Surgery, University Hospital Centre Ljubljana, Ljubljana, Slovenia
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Sef D, Birdi I. Clinically significant incidental findings during preoperative computed tomography of patients undergoing cardiac surgery. Interact Cardiovasc Thorac Surg 2020; 31:629-631. [PMID: 32865197 DOI: 10.1093/icvts/ivaa160] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/16/2020] [Accepted: 07/20/2020] [Indexed: 11/12/2022] Open
Abstract
With the development of minimally invasive cardiac surgery, chest and abdominal computed tomography (CT) scans are becoming an integral part of preoperative assessment and planning. Therefore, the number of incidental findings (IFs) detected with CT is rising. We aimed to investigate the frequency of clinically significant IFs on chest and abdominal CT scans performed during the preoperative assessment of patients undergoing adult cardiac surgery in a 2-year period. In a cohort of 401 patients (mean age 67.4 ± 12.3, female gender 28.9%, median logistic EuroSCORE 5.8 [0.9, 90.5]) who underwent chest or abdominal CT imaging during the study period, we identified 75 patients (18.7%) with clinically significant IFs who needed a further treatment or work-up to confirm the diagnosis or postoperative follow-up. Our data indicate that clinically significant IFs in patients referred for cardiac surgery are frequent. It is important to identify clinically significant Ifs, as a clear postoperative follow-up plan should be made.
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Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Inderpaul Birdi
- Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, UK
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34
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Sef D, Verzelloni Sef A, Mohite P, Stock U, Trkulja V, Raj B, Garcia Saez D, Mahesh B, De Robertis F, Simon A. Utilization of extracorporeal membrane oxygenation in DCD and DBD lung transplants: a 2-year single-center experience. Transpl Int 2020; 33:1788-1798. [PMID: 32989785 DOI: 10.1111/tri.13754] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/26/2020] [Accepted: 09/22/2020] [Indexed: 01/23/2023]
Abstract
Donation after circulatory death (DCD) has the potential to expand the lung donor pool. We aimed to assess whether DCD affected the need for perioperative extracorporeal membrane oxygenation (ECMO) and perioperative outcomes in lung transplantation (LTx) as compared to donation after brain death (DBD). All consecutive LTxs performed between April 2017 and March 2019 at our tertiary center were analyzed. Donor and recipient preoperative characteristics, utilization of ECMO, and perioperative clinical outcomes were compared between DCD and DBD LTx. Multivariate models (frequentist and Bayes) were fitted to evaluate an independent effect of DCD on the intra- and postoperative need for ECMO. Out of 105 enrolled patients, 25 (23.8%) were DCD LTx. Donors' and preoperative recipients' characteristics were comparable between the groups. Intraoperatively, mechanical circulatory support (MCS) was more common in DCD LTx (56.0% vs. 36.2%), but the adjusted difference was minor (RR = 1.16, 95% CI 0.64-2.12; P = 0.613). MCS duration, and first and second lung ischemia time were longer in the DCD group. Postoperatively, DCD recipients more commonly required ECMO (32.0% vs. 7.5%) and the difference remained considerable after adjustment for the pre- and intraoperative covariates: RR = 4.11 (95% CI 0.95-17.7), P = 0.058, Bayes RR = 4.15 (95% CrI 1.28-13.0). Sensitivity analyses (two DCD-DBD matching procedures) supported a higher risk of postoperative ECMO need in DCD patients. Incidence of delayed chest closure, postoperative chest drainage, and renal replacement therapy was higher in the DCD group. Early postoperative outcomes after DCD LTx appeared generally comparable to those after DBD LTx. DCD was associated with a higher need for postoperative ECMO which could influence clinical outcomes. However, as the DCD group had a significantly higher use of EVLP with more common ECMO preoperatively, this might have contributed to worse outcomes in the DCD group.
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Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Alessandra Verzelloni Sef
- Department of Anaesthesia and Critical Care, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Prashant Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Vladimir Trkulja
- Department of Pharmacology, Zagreb University School of Medicine, Zagreb, Croatia
| | - Binu Raj
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Diana Garcia Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Balakrishnan Mahesh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Andre Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, UK
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Sef D, Predrijevac M, Raja SG, Turina MI. Is it better to treat bypass graft or native coronary artery following early graft failure? J Card Surg 2020; 36:9-11. [PMID: 33085109 DOI: 10.1111/jocs.15144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 10/09/2020] [Accepted: 10/11/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Davorin Sef
- Department of Cardiac Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Mladen Predrijevac
- Department of Cardiac Surgery, Magdalena Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Shahzad G Raja
- Department of Cardiac Surgery, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
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36
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Sef AV, Sef D, Raj B, Day H, Mitchell J, Walker C, Mattison S, McGovern I, Simon A, Kuppurao L. Perioperative transfusion practice in patients undergoing lung transplantation – experience from a 7-year period. J Cardiothorac Vasc Anesth 2020. [DOI: 10.1053/j.jvca.2020.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Sef D, Wei LM, Rankin JS, Spear CR, Gustafson RA, Badhwar V. Robotic-assisted two-patch repair of right partial anomalous pulmonary venous connection and sinus venosus defect. JTCVS Tech 2020; 4:262-264. [PMID: 34318037 PMCID: PMC8303067 DOI: 10.1016/j.xjtc.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 07/29/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom
| | - Lawrence M Wei
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - J Scott Rankin
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | | | - Robert A Gustafson
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WVa
| | - Vinay Badhwar
- Department of Cardiothoracic Surgery and Transplant Unit, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, London, United Kingdom
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Sef D, Mohite P, De Robertis F, Verzelloni Sef A, Mahesh B, Stock U, Simon A. Bridge to heart transplantation using the Levitronix CentriMag short-term ventricular assist device. Artif Organs 2020; 44:1006-1008. [PMID: 32367538 DOI: 10.1111/aor.13709] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 03/26/2020] [Accepted: 04/17/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Davorin Sef
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Prashant Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Alessandra Verzelloni Sef
- Department of Anesthesia and Critical Care, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Balakrishnan Mahesh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Ulrich Stock
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
| | - Andre Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, London, UK
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Sef D, Szavits-Nossan J, Predrijevac M, Golubic R, Sipic T, Stambuk K, Korda Z, Meier P, Turina MI. Management of perioperative myocardial ischaemia after isolated coronary artery bypass graft surgery. Open Heart 2019; 6:e001027. [PMID: 31168389 PMCID: PMC6519404 DOI: 10.1136/openhrt-2019-001027] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/04/2019] [Accepted: 04/12/2019] [Indexed: 11/06/2022] Open
Abstract
Objectives Updated knowledge about perioperative myocardial ischaemia (MI) after coronary artery bypass grafting (CABG) and treatment of acute graft failure is needed. We analysed main factors associated with perioperative MI and effects of immediate coronary angiography-based treatment strategy on patient outcome. Methods Among 1119 consecutive patients with coronary artery disease who underwent isolated CABG between January 2011 and December 2015, 43 (3.8%) patients underwent urgent coronary angiography due to suspected perioperative MI. All the data were prospectively collected and retrospectively analysed. The primary endpoint was 30-day mortality; postoperative left ventricular ejection fraction) and major adverse cardiac events were secondary endpoints. Results Overall, 30-day mortality in patients with CABG was 1.4% while in patients who developed perioperative MI was 9% (4 patients). Angiographic findings included incorrect graft anastomosis, graft spasm, dissection, acute coronary artery thrombotic occlusion and ischaemia due to incomplete revascularisation. Emergency reoperation (Redo) was performed in 14 (32%), acute percutaneous coronary intervention (PCI) in 15 (36%) and conservative treatment (Non-op) in 14 patients. Demographic and preoperative clinical characteristics between the groups were comparable. Postoperative LVEF was significantly reduced in the Redo group (45% post-op vs 53% pre-op) and did not change in groups PCI (56% post-op vs 57% pre-op) and Non-op (58% post-op vs 57% pre-op). Conclusions Urgent angiography allows identification of the various underlying causes of perioperative MI and urgent treatment when this is needed. Urgent PCI may be associated with improved clinical outcome in patients with early graft failure.
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Affiliation(s)
| | - Janko Szavits-Nossan
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Mladen Predrijevac
- J.J. Strossmayer University, Osijek, Croatia.,Department of Cardiovascular Surgery, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Rajna Golubic
- Papworth Hospital NHS Foundation Trust, Cambridge, Cambridgeshire, UK
| | - Tomislav Sipic
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Kresimir Stambuk
- Department of Cardiology, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.,J.J. Strossmayer University, Osijek, Croatia
| | - Zvonimir Korda
- Department of Cardiovascular Surgery, Magdalena - Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Pascal Meier
- Royal Brompton and Harefield NHS Foundation Trust, London, London, UK.,Kantonsspital Graubunden, Chur, GR, Switzerland
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Sef D, Skopljanac-Macina A, Milosevic M, Skrtic A, Vidjak V. Cerebral Neuromonitoring during Carotid Endarterectomy and Impact of Contralateral Internal Carotid Occlusion. J Stroke Cerebrovasc Dis 2018; 27:1395-1402. [PMID: 29397311 DOI: 10.1016/j.jstrokecerebrovasdis.2017.12.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/03/2017] [Accepted: 12/21/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The aim of this study was to identify the reliability of carotid artery stump pressure (SP) in predicting the neurologic changes and correlation with contralateral internal carotid artery (ICA) occlusion in patients undergoing eversion carotid endarterectomy (CEA). The optimal method for monitoring cerebral perfusion during CEA, performed under either local or general anesthesia, is still controversial. METHODS We prospectively analyzed 118 consecutive patients undergoing eversion CEA under local anesthesia. We had 78 symptomatic (66%) and 40 asymptomatic patients (33.9%). Selective shunting was performed in patients who developed neurologic changes after carotid clamping regardless of SP. Correlation of preoperative symptom status, a degree of stenosis, status of contralateral ICA, arterial blood pressure, SP value, and the intraoperative need for shunting due to neurologic changes was evaluated for both groups: shunted and nonshunted. RESULTS Selective shunting was performed in 12 patients (10%). There was no significant difference among the groups regarding the demographic characteristics. Mean carotid clamping time was 14.57 minutes. We had no perioperative mortality, stroke, or myocardial infarction. None of the patients required conversion to general anesthesia. We found a mean SP of 31 mm Hg as a reliable threshold for shunting (P < .001; sensitivity 92.3%; specificity 91.3%). Contralateral carotid occlusion was correlated with the significantly lower SP (27 ± 13 mm Hg; P = .001) and the higher need for shunt (50%). CONCLUSIONS SP measurement is a reliable and simple method for monitoring the collateral cerebral perfusion and can predict the need for shunting during CEA. Patients with the contralateral ICA occlusion showed significantly lower SP, although it did not have impact on the outcome.
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Affiliation(s)
- Davorin Sef
- Department of Cardiovascular Surgery, Magdalena, Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.
| | - Andrija Skopljanac-Macina
- Department of Cardiovascular Surgery, Magdalena, Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia
| | - Milan Milosevic
- School of Medicine, Andrija Stampar School of Public Health, University of Zagreb, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Anita Skrtic
- Department of Pathology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Vinko Vidjak
- Department of Diagnostic and Interventional Radiology, University Hospital Merkur, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
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Abstract
We describe the resection for lipomatous hypertrophy of the interatrial septum which necessitated complete reconstruction of the right atrium with Dacron grafts connecting the superior and inferior vena cava with the tricuspid orifice, and connection of the pulmonary veins to the mitral orifice with xenopericardium.
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Affiliation(s)
- Davorin Sef
- Department of Cardiovascular Surgery, "Magdalena"-Clinic for Cardiovascular Diseases, Krapinske Toplice, Croatia.
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Kocman B, Sef D, Buhin M, Erdelez L, Mikulic D, Filipec-Kanizaj T. Simultaneous Orthotopic Liver Transplantation With Abdominal Aortic Aneurysm Repair: A Case Report. EXP CLIN TRANSPLANT 2016; 16:219-221. [PMID: 27228151 DOI: 10.6002/ect.2015.0325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The simultaneous occurrence of an abdominal aortic aneurysm and liver cirrhosis needing surgical treatment is extremely rare. There is still controversy regarding the timing of abdominal aortic aneurysm repair and liver transplantation and regarding optimal treatment of the aneurysm. Here, we describe a 70-year-old white male patient who presented with end-stage liver disease secondary to chronic hepatitis C with a solitary hepatocellular carcinoma measuring 5.5 cm in diameter in the right liver lobe. A pretransplant work-up resulted in discovery of a 6.7-cm abdominal aortic aneurysm. The decision was made to perform orthotopic liver transplantation with simultaneous aneurysm repair. The patient was initially explored through a median laparotomy. The liver transplant was performed first with the graft prepared on the back table using a standard procedure. The liver graft was transplanted using a "piggy-back" technique with end-to-side caval and end-to-end portal vein anastomosis. The arterial anastomosis was performed with an end-to-end anastomosis between the donor's proper hepatic artery and the recipient's common hepatic artery. The bile duct anastomosis was performed with an end-to-end anastomosis. A midline incision was extended to the pubis. After proximal and distal vascular control of the infrarenal aorta, resection of the abdominal aortic aneurysm was performed followed by reconstruction with an InterVascular 22-mm prosthesis using 3.0 Prolene in a running fashion. Eight days after surgery, the patient was discharged and remained well during the 2-year follow-up. Although rare, in a patient with end-stage liver disease and abdominal aortic aneurysm, a simultaneous liver transplantation and aneurysm repair procedure represents the safest treatment solution.
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Affiliation(s)
- Branislav Kocman
- From the Department of Abdominal Surgery, Division of Transplantation Surgery, University Hospital Merkur, Zagreb, Croatia
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Jadrijevic S, Sef D, Kocman B, Mrzljak A, Matasic H, Skegro D. Right hepatectomy due to portal vein thrombosis in vasculobiliary injury following laparoscopic cholecystectomy: a case report. J Med Case Rep 2014; 8:412. [PMID: 25481385 PMCID: PMC4295332 DOI: 10.1186/1752-1947-8-412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/16/2014] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Vasculobiliary injury composed of bile duct, portal vein and hepatic artery injury is a rare, but the most severe, complication after cholecystectomy that may require hepatectomy or even urgent liver transplantation. CASE PRESENTATION We present a case of a 36-year-old Caucasian woman with a biliary sepsis and a large right liver lobe abscess due to an extreme vasculobiliary injury after laparoscopic cholecystectomy. Bismuth type IV biliary duct injury, portal vein thrombosis and injury of right hepatic artery were identified, resulting in life-threatening septic episodes. Right hepatectomy with Roux-en-Y hepaticojejunostomy and reconstruction of her portal vein with a vein allograft were performed. She fully recovered and remained well during 3 years of follow-up. CONCLUSIONS Although rare, the impact of vasculobiliary injuries after cholecystectomy highlights the need for constant alertness and prompt management in order to minimize the risk of the routine operative procedure. Hepatectomy with biliary and vascular reconstruction should be considered early in the management of vasculobiliary injury to avoid the development of life-threatening consequences.
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Affiliation(s)
- Stipislav Jadrijevic
- Department of Surgery, Division of Transplantation Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Davorin Sef
- Department of Surgery, Division of Transplantation Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Branislav Kocman
- Department of Surgery, Division of Transplantation Surgery, University Hospital Merkur, Zagreb, Croatia
| | - Anna Mrzljak
- Department of Medicine, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Hrvoje Matasic
- Department of Anesthesiology and Critical Care, University Hospital Merkur, Zagreb, Croatia
| | - Dinko Skegro
- Department of Medicine, University Hospital Merkur, Zagreb, Croatia
- School of Medicine, University of Zagreb, Zagreb, Croatia
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Abstract
OBJECTIVE Chronic post-traumatic arteriovenous fistula (AVF) is a late complication of vascular injury and can be presented with symptoms of congestive heart failure, venous hypertension and distal ischaemia. We present an unusual case of chronic ischaemic leg ulcer in young adult caused by post-traumatic AVF. Case report A 29-year-old male patient was admitted to our hospital with symptoms of chronic ulcer located on the lateral side of the lower left leg. Arterial pulses distally from the groin were absent. His medical history revealed him to have sustained gunshot injury of the left thigh in the war conflict 18 years before. Angiography showed a large AVF between superficial femoral artery and femoral vein. The patient underwent surgical repair of AVF with reconstruction of superficial femoral artery by saphenous vein interposition under spinal anaesthesia. Completion angiography confirmed AVF exclusion. Leg ulcer healed within a month. CONCLUSION Chronic leg ulcer may be the only symptom of large post-traumatic AVF in young adults.
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Affiliation(s)
- S Suknaic
- Department of Vascular Surgery, University Hospital ‘Merkur’, Zajceva, Zagreb
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Skopljanac Macina A, Erdelez L, Sef D, Suknaić S, Hlevnjak D, Buhin M, Gustin D. [Minimally invasive aortic surgery (MIAS)]. Lijec Vjesn 2008; 130:187-190. [PMID: 18979906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
In this study we presented benefits of minimally invasive approach (MIAS) for treating abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD). MIAS technique consisted of minilaparotomy approach using incision length of 7-12 cm, intraabdominal small bowel retraction and standard aortic reconstruction with terminoterminal anastomosis or aortobifemoral bypass. Between December 2004 and January 2007 we perfomed 32 repairs for AAA and AIOD using MIAS technique. Mean infrarenal aortic cross clamp time was 48.5 +/- 17 minutes. Duration ofnasogastric suction and period before starting liquid diet was meanly 1.2 +/- 0.5 days. Mean time of stay in intensive care unit was 1.3 +/- 0.6 days, and hospital stay was 7.1 +/- 1.4 days. We had no 30-day mortality rate and there was no wound infection. MIAS technique is a safe method for the treatment of infrarenal AAA and AIOD including smaller wound size, shorter duration of postoperative ileus, intensive care unit stay and hospital stay, and lower hospital costs compared with those of standard way of treatment.
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Affiliation(s)
- Andrija Skopljanac Macina
- Odjel za vaskularnu kirurgiju, Klinika za kirurgiju Medicinskog fakulteta u Zagrebu, Klinicka bolnica Merkur, Zajceva 19, 10000 Zagreb
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Salamon A, Salamon T, Sef D, Jo-Osvatić A. Morphological characteristics of the acetabulum. Coll Antropol 2004; 28 Suppl 2:221-6. [PMID: 15571095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The aim of this research was to accurately measure the surface of the semi lunar articular surface of the pelvis (facies lunata acetabuli) and the variability of the acetabular geometry, as well as to determine the correlation between measured parameters. 30 macerated anatomical specimens of pelvic bones were measured. The radius and depth were measured in the classical way, while cartilaginous surface area was measured using small fragments of measuring paper to avoid errors in measurement due to the curvature of the surface. Computerized calculations provided accurate surface values. In our research, facies lunata acetabuli measured 2294+/-329 mm2. Diameter of the opening of the acetabulum measured 25.8+/-1.9 mm. Acetabular depth was 30+/-3.2 mm. Correlations between the surface area of the facies lunata acetabuli and the radius of the acetabular opening curvature (r=0.71), surface area of the facies lunata acetabuli and the depth of the acetabulum (r=0.80) and the radius of the acetabular opening curvature and the depth of the acetabulum (r=0.80) were confirmed. For precise assessment of the facies lunata acetabuli surface area, the simplest and the cheapest method is the method of measurement using small fragments of measuring paper and software analysis. There is a significant correlation between the depth, opening of the acetabulum and surface area of the facies lunata.
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Affiliation(s)
- Antun Salamon
- Department of Surgery, University Hospital Dubrava, Zagreb, Croatia
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