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Nestorovic E, Mariani S, Schmitto JD, Pantovic A. Posterior Reversible Encephalopathy Syndrome after Heart Transplantation: A 17-year-old Boy's Case. Neurol India 2023; 71:817-818. [PMID: 37635538 DOI: 10.4103/0028-3886.383863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Affiliation(s)
- Emilija Nestorovic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Silvia Mariani
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - Jan D Schmitto
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
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Matkovic M, Milicevic V, Bilbija I, Aleksic N, Cubrilo M, Nestorovic E, Antic A, Zlatkovic M, Velinovic M, Putnik S. Pulmonary Artery Hypertension as A Risk Factor for Long-Term Survival after Heart Transplantation. Heart Surg Forum 2021; 24:E544-E549. [PMID: 34173749 DOI: 10.1532/hsf.3789] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/22/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Heart failure is the most frequent cause of pulmonary artery hypertension (PAH) and its severity may predict the development of heart failure (HF) and is known to be a prognostic factor of poor outcome after heart transplant (HTx). The aim of this study was to investigate the impact of preoperative PAH related to left-sided HF on long-term survival after HTx and to identify the hemodynamic parameters of PAH that predict survival after HTx. METHODS A prospective observational trial was performed, and it included 44 patients subjected to heart transplantation. Patients were divided into two groups: The first one with the preoperative diagnosis of PAH and the second one without the PAH diagnosed prior to the HTx. The two groups were compared for baseline characteristics, operative characteristics, survival, and hemodynamic parameters obtained by right heart catheterization. Survival was analyzed using Kaplan Meyer analysis, and Cox regression analysis was performed to determine independent predictors of survival. RESULTS The median follow-up time was 637.4 days (1-2028 days). The median survival within the group of patients with preoperative PAH was 1144 days (95% CI 662.884-1625.116) and 1918.920 days (95% CI 1594.577-2243.263) within the group of patients without PAH (P = .023), HR 0.279 (95% [CI]: 0.086-0.910; P = .034. The 30-day mortality in patients within PAH group was significantly higher, six versus two patients in the non PAH group (χ2 = 5.103, P < .05), while the long-term outcome after this period did not differ between the groups. Patients with preoperative PAH had significantly higher values of MPAP, PCWP, TPG and PVRI, while CO and CI did not differ between the two groups. Mean PVRI was 359.1 ± 97.3 dyn·s·cm-5 in the group with preoperative PAH and 232.2 ± 22.75 dyn·s·cm-5 in the group without PAH, P < .001. TPG values were 11.95 ± 5.08 mmHg in the PAH group while patients without PAH had mean values of 5.16 ± 1.97 mmHg, P < .001. Cox regression analysis was done for the aforementioned parameters. Hazard ratio for worse survival after HTx for elevated values of PVRI was 1.006 (95% [CI]: 1.001-1.012; P = .018) TPG had a hazard ratio of 1.172 (95% [CI]: 1.032-1.233; P = .015). CONCLUSION Pulmonary artery hypertension is an independent risk factor for higher 30-day mortality after HTx, while it does not affect the long-term outcome. Hemodynamic parameters obtained by right heart catheterization in heart transplant candidates could predict postoperative outcome. PVRI and TPG have been identified as independent predictors of higher 30-day postoperative mortality.
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Affiliation(s)
- Milos Matkovic
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Vladimir Milicevic
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Ilija Bilbija
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Nemanja Aleksic
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Marko Cubrilo
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Emilija Nestorovic
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Ana Antic
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Mina Zlatkovic
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Milos Velinovic
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
| | - Svetozar Putnik
- Department for Cardiac Surgery, University Clinical Center of Serbia, Belgrade, Serbia.
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Pavlovic V, Weissgerber T, Stanisavljevic D, Pekmezovic T, Milicevic O, Lazovic JM, Cirkovic A, Savic M, Rajovic N, Piperac P, Djuric N, Madzarevic P, Dimitrijevic A, Randjelovic S, Nestorovic E, Akinyombo R, Pavlovic A, Ghamrawi R, Garovic V, Milic N. How accurate are citations of frequently cited papers in biomedical literature? Clin Sci (Lond) 2021; 135:671-681. [PMID: 33599711 PMCID: PMC8048031 DOI: 10.1042/cs20201573] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/20/2021] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/17/2022]
Abstract
Citations are an important, but often overlooked, part of every scientific paper. They allow the reader to trace the flow of evidence, serving as a gateway to relevant literature. Most scientists are aware of citations' errors, but few appreciate the prevalence of these problems. The purpose of the present study was to examine how often frequently cited papers in biomedical scientific literature are cited inaccurately. The study included an active participation of the first authors of included papers; to first-hand verify the citations accuracy. Findings from feasibility study, where we reviewed 1540 articles containing 2526 citations of 14 most cited articles in which the authors were affiliated with the Faculty of Medicine University of Belgrade, were further evaluated for external confirmation in an independent verification set of articles. Verification set included 4912 citations identified in 2995 articles that cited 13 most cited articles published by authors affiliated with the Mayo Clinic Division of Nephrology and Hypertension. A citation was defined as being accurate if the cited article supported or was in accordance with the statement by citing authors. At least one inaccurate citation was found in 11 and 15% of articles in the feasibility study and verification set, respectively, suggesting that inaccurate citations are common in biomedical literature. The most common problem was the citation of nonexistent findings (38.4%), followed by an incorrect interpretation of findings (15.4%). One-fifth of inaccurate citations were due to chains of inaccurate citations. Based on these findings, several actions to reduce citation inaccuracies have been proposed.
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Affiliation(s)
- Vedrana Pavlovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tracey Weissgerber
- Charité - Universitätsmedizin Berlin, Berlin Institute of Health, QUEST Center, Berlin
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ognjen Milicevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Milin Lazovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andja Cirkovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marko Savic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Pavle Piperac
- Department of Humanities, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nemanja Djuric
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Petar Madzarevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ana Dimitrijevic
- Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Simona Randjelovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Emilija Nestorovic
- Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Remi Akinyombo
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrija Pavlovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ranine Ghamrawi
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN U.S.A
| | - Vesna Garovic
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN U.S.A
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN U.S.A
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Vukmirovic M, Rajovic N, Pavlovic V, Masic S, Mirkovic M, Tasic R, Randjelovic S, Mostic D, Velickovic I, Nestorovic E, Milcanovic P, Stanisavljevic D, Milic N. The Burnout Syndrome in Medical Academia: Psychometric Properties of the Serbian Version of the Maslach Burnout Inventory-Educators Survey. Int J Environ Res Public Health 2020; 17:E5658. [PMID: 32764447 PMCID: PMC7460250 DOI: 10.3390/ijerph17165658] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 11/17/2022]
Abstract
The aim of this study was to assess the psychometric properties of the Maslach Burnout Inventory-Educators Survey (MBI-ES). The presence of burnout syndrome, its relationship with personality traits, intention to change career and work abroad were assessed in a cross-sectional multi-center trial conducted among educators at three medical faculties in the Western Balkans during 2019. Translation and cultural adaptation were made based on internationally accepted principles. Personality traits were assessed by the Big Five Plus Two questionnaire. In total, 246 medical faculty members, predominantly females (61%), were enrolled. The three-factor structure of the MBI-ES questionnaire (exhaustion, cynicism, and professional efficacy) was validated. Analysis of internal consistency yielded a Cronbach's alpha of 0.785, indicating scale reliability. The majority of respondents (85.6%) reported moderate level of burnout. Aggressiveness, neuroticism, and negative valence were associated with emotional exhaustion and depersonalization, while extraversion, conscientiousness, openness, and positive valence correlated with personal accomplishment. Emotional exhaustion and depersonalization in a multivariate regression model were significantly associated with intentions to change career and work abroad (p < 0.05). The present study provided evidence for the appropriate metric properties of the Serbian version of MBI-ES. Presence of burnout syndrome, which was identified as a common problem in medical academia, and directly linked to personality traits, affected intention to career change and work abroad.
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Affiliation(s)
- Marijana Vukmirovic
- Center for Informatics and Biostatistics, Belgrade Public Health Institute, 11000 Belgrade, Serbia;
| | - Nina Rajovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (V.P.); (P.M.); (D.S.)
| | - Vedrana Pavlovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (V.P.); (P.M.); (D.S.)
| | - Srdjan Masic
- Department for Public Health, Faculty of Medicine, University of East Sarajevo, 73300 East Sarajevo, Bosnia and Herzegovina;
| | - Momcilo Mirkovic
- Institute of Social Medicine, Faculty of Medicine, University of Pristina, 38220 Kosovska Mitrovica, Serbia;
| | - Radica Tasic
- Medical School, Academy of Vocational Studies Belgrade, 11000 Belgrade, Serbia; (R.T.); (I.V.)
| | - Simona Randjelovic
- Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.R.); (D.M.); (E.N.)
| | - Danka Mostic
- Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.R.); (D.M.); (E.N.)
| | - Igor Velickovic
- Medical School, Academy of Vocational Studies Belgrade, 11000 Belgrade, Serbia; (R.T.); (I.V.)
| | - Emilija Nestorovic
- Clinical Center of Serbia, 11000 Belgrade, Serbia; (S.R.); (D.M.); (E.N.)
| | - Petar Milcanovic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (V.P.); (P.M.); (D.S.)
| | - Dejana Stanisavljevic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (V.P.); (P.M.); (D.S.)
| | - Natasa Milic
- Institute for Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (N.R.); (V.P.); (P.M.); (D.S.)
- Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55902, USA
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Terzic D, Nestorovic E, Markovic D, Kovacevic Kostic N, Djordjevic A, Karan R, Cubrilo M, Stojiljkovic V, Milićević V, Cumic J, Putnik S. Surgical Challenges of Heart Mate 3 Pump Implantation in Aneurysmally Changed Heart Ventricles. Heart Surg Forum 2020; 23:E393-E396. [PMID: 32524987 DOI: 10.1532/hsf.2721] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 04/28/2020] [Indexed: 11/20/2022]
Abstract
We presented surgical treatment of three patients indicated for implantation of a permanent mechanical circulatory support device and with the associated left ventricular aneurysms. In order to evade the left ventricular rupture, adverse thromboembolic events and provide safe implantation of the inflow cannula, LVAD HM3 implantation together with the reconstruction of the left ventricular aneurysmal wall was performed in two patients. Regarding the third patient, LVAD implantation upon the reconstruction of the left ventricular wall was abandoned because there was no safe location for placement of the inflow cannula.
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Affiliation(s)
- Dusko Terzic
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Emilija Nestorovic
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dejan Markovic
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Kovacevic Kostic
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandar Djordjevic
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Radmila Karan
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Marko Cubrilo
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Vladimir Milićević
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Cumic
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Svetozar Putnik
- Department for Heart Transplant, LVAD and ECMO, Clinic for Cardiac surgery, Clinical Center of Serbia, Belgrade, Serbia
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Terzic D, Nestorovic E, Ceranic M, Mikic A, Milicevic V, Putnik S. The Challenges to Abdominal and Cardiac Surgeons: Emergency Splenectomy after LVAD Implantation-A Case Report. Heart Surg Forum 2019; 22:E024-E026. [PMID: 30802193 DOI: 10.1532/hsf.2107] [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: 07/17/2018] [Accepted: 09/14/2018] [Indexed: 11/20/2022]
Abstract
The paper presents collaboration of an abdominal surgeon and heart team in deciding upon surgical management of a patient with the implanted left ventricular assist device, who has undergone emergency abdominal operation for spleen rupture. The paper focuses on the significance of prompt diagnostics, clinical challenges of hemodynamic and anticoagulant treatment, abdominal organ exposure along the placed left ventricular assist device driveline, identification of vascular structures in conditions of continuous blood flow, and reconstruction of the surgical wound in the driveline projection.
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Affiliation(s)
- Dusko Terzic
- Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Miljan Ceranic
- Clinic for Digestive Surgery, Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | - Aleksandar Mikic
- Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade Faculty of Medicine, Belgrade, Serbia
| | | | - Svetozar Putnik
- Clinic for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia.,University of Belgrade Faculty of Medicine, Belgrade, Serbia
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Nestorovic E, Schmitto JD, Kushwaha SS, Putnik S, Terzic D, Milic N, Mikic A, Markovic D, Trifunovic D, Ristic A, Ristic M. Successful establishment of a left ventricular assist device program in an emerging country: one year experience. J Thorac Dis 2018; 10:S1743-S1750. [PMID: 30034847 DOI: 10.21037/jtd.2018.04.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Background The primary goal of this study was to evaluate the outcomes of patients with end-stage heart failure (HF) who underwent continuous flow left ventricular assist device (CF-LVAD) in a developing country and to compare to those reported by more developed countries. The secondary goal was on determining factors that may be connected to improved survival. Methods We prospectively analyzed 47 consecutive patients who underwent CF-LVAD at our institution. After one year the survival and adverse event profiles of patients were evaluated. At 3, 6 and 12 months, the cardiac, renal and liver function outcomes were assessed. Results The 30-day, 6-month and 1-year survival rates were 89%, 85% and 80%, respectively. A significant improvement in dimensions and ejection fraction of left ventricle, BNP, functional capacity, blood urea nitrogen (BUN) and total bilirubin (P<0.05 for all) were noticed 3 months post-CF-LVAD implantation, and patients were stable throughout the entire first year follow up. In the group of patients with baseline renal dysfunction (RD) there were significant improvements of renal function (P=0.004), with no changes on follow up. 57% of patients exhibited some kind of adverse event, commonly in the form of bleeding. In multivariate Cox regression analysis renal failure was found to be as an independent risk factor for the overall survival (HR =13.1, P<0.001). Conclusions In conclusion, our data extends previous findings from centers of developed countries, that CF-LVAD is an adequate treatment option for patients suffering from end-stage HF, and encourages expansion of CF-LVAD implantation in developing countries with nascent HT program.
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Affiliation(s)
- Emilija Nestorovic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Jan D Schmitto
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Sudhir S Kushwaha
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Svetozar Putnik
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dusko Terzic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Natasa Milic
- Department for Medical Statistics and Informatics, Medical Faculty University of Belgrade, Belgrade, Serbia.,Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Aleksandar Mikic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
| | - Dejan Markovic
- Center for Anesthesiology and Resuscitation, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Arsen Ristic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Miljko Ristic
- Department for Heart Transplant, LVAD and ECMO, Hospital for Cardiac Surgery, Clinical Center of Serbia, Belgrade, Serbia
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Terzic D, Nestorovic E, Putnik S, Markovic D, Ristic M. Kinking of the Outflow Graft, Consequent Ventricular Tachycardia, and the Need for Reoperation in a Patient with Left Ventricular Assist Device. Heart Surg Forum 2017; 20:E139-E141. [DOI: 10.1532/hsf.1848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/05/2017] [Indexed: 11/20/2022]
Abstract
Background: Left ventricular assist devices (LVAD) have become a lifesaving solution for patients awaiting heart transplantation as well as an option to support the failing hearts of non-transplant candidates as a lifelong, or destination therapy (DT). Improvements in LVAD design have enabled greater durability and broader patient applicability, but not without complications. Ventricular arrhythmias in LVAD patients were considered benign in the early days of LVADs, but today are increasingly recognized for their harmful impact on morbidity and quality of life.Case presentation: We describe a 53-year-old male who underwent HeartWare left ventricular assist device (HVAD) implantation. During the postoperative period, the patient experienced ventricular tachycardia (VT) during a coughing episode, later found on CT to be due to significant angulation of the outflow graft. Following reoperation to shorten the outflow graft, the patient returned to hemodynamic stability, without VT or other arrhythmias.Conclusions: Innovative strategies in VT prevention and improved clinical outcomes in LVAD patients may be the result of better understanding of characteristics that predispose these patients to VT. This case report showed that an excessively long outflow graft with considerable kinking created significant VT, but reoperation to correct the length of the graft mitigated further VT complications.
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Velickovic I, Milin-Lazovic J, Nestorovic E, Cirkovic A, Savic M, Stojkovic N, Masic S, Milic N. Comparison of different definitions of the metabolic syndrome in relation to coronary artery disease in high risk Serbian population. Praxis Med 2015. [DOI: 10.5937/pramed1501115v] [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: 11/02/2022] Open
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Trifunovic D, Stankovic S, Sobic-Saranovic D, Marinkovic J, Petrovic M, Orlic D, Beleslin B, Banovic M, Vujisic-Tesic B, Petrovic M, Nedeljkovic I, Stepanovic J, Djordjevic-Dikic A, Tesic M, Djukanovic N, Petrovic O, Vasovic O, Nestorovic E, Kostic J, Ristic A, Ostojic M. Acute insulin resistance in ST-segment elevation myocardial infarction in non-diabetic patients is associated with incomplete myocardial reperfusion and impaired coronary microcirculatory function. Cardiovasc Diabetol 2014; 13:73. [PMID: 24708817 PMCID: PMC4234386 DOI: 10.1186/1475-2840-13-73] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Accepted: 04/02/2014] [Indexed: 12/13/2022] Open
Abstract
Background Insulin resistance (IR) assessed by the Homeostatic Model Assessment (HOMA) index in the acute phase of myocardial infarction in non-diabetic patients was recently established as an independent predictor of intrahospital mortality. In this study we postulated that acute IR is a dynamic phenomenon associated with the development of myocardial and microvascular injury and larger final infarct size in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (pPCI). Methods In 104 consecutive patients with the first anterior STEMI without diabetes, the HOMA index was determined on the 2nd and 7th day after pPCI. Worst-lead residual ST-segment elevation (ST-E) on postprocedural ECG, coronary flow reserve (CFR) determined by transthoracic Doppler echocardiography on the 2nd day after pPCI and fixed perfusion defect on single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) determined six weeks after pPCI were analyzed according to HOMA indices. Results IR was present in 55 % and 58 % of patients on day 2 and day 7, respectively. Incomplete post-procedural ST-E resolution was more frequent in patients with IR compared to patients without IR, both on day 2 (p = 0.001) and day 7 (p < 0.001). The HOMA index on day 7 correlated with SPECT-MPI perfusion defect (r = 0.331), whereas both HOMA indices correlated well with CFR (r = -0.331 to -0.386) (p < 0.01 for all). In multivariable backward logistic regression analysis adjusted for significant univariate predictors and potential confounding variables, IR on day 2 was an independent predictor of residual ST-E ≥ 2 mm (OR 11.70, 95% CI 2.46-55.51, p = 0.002) and CFR < 2 (OR = 5.98, 95% CI 1.88-19.03, p = 0.002), whereas IR on day 7 was an independent predictor of SPECT-MPI perfusion defect > 20% (OR 11.37, 95% CI 1.34-96.21, p = 0.026). Conclusion IR assessed by the HOMA index during the acute phase of the first anterior STEMI in patients without diabetes treated by pPCI is independently associated with poorer myocardial reperfusion, impaired coronary microcirculatory function and potentially with larger final infarct size.
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Affiliation(s)
- Danijela Trifunovic
- Department of Cardiology, Clinical Centre of Serbia, Ul, Koste Todorovica 8, 11000 Belgrade, Serbia.
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Kocica MJ, Ristic M, Cvetkovic D, Soskic L, Nestorovic E, Corno AF, Kanjuh VI, Lackovic V. Three-layered ventricular septum of the helical heart: functional anatomy and clinical relevance. J Cardiothorac Surg 2013. [PMCID: PMC3844466 DOI: 10.1186/1749-8090-8-s1-o106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Milic N, Parapid B, Ostojic MC, Nedeljkovic M, Nestorovic E, Marinkovic J. Safety and cost-effectiveness of DES vs. BMS: evidence from accomplished 5 years' follow up RCTs. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht309.p3348] [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: 11/14/2022] Open
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