1
|
Granov N, Hadžimehmedagić A, Šljivo A, Selimović T, Kurtagić D, Kabil E, Djedović M, Abdulkhaliq A. Comparison between conventional open-heart valve surgery and minimally invasive valve replacement surgery regarding the length of hospital stay and usage of blood derivates: insights from a single-centre, single-surgeon study conducted in Bosnia and Herzegovina. Med Glas (Zenica) 2024; 21:91-97. [PMID: 38341642 DOI: 10.17392/1670-23] [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] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/06/2023] [Accepted: 11/22/2023] [Indexed: 02/12/2024]
Abstract
Aim To analyse the correlation between different surgical methodologies employed in valve diseases treatment and their subsequent impact on the duration of hospitalization. Methods This retrospective study conducted at the Clinical Centre of the University of Sarajevo analysed medical records of 163 valve disease patients treated between January 2019 and November 2022. The patients were divided into two groups: 77 had openheart valve surgery and 86 underwent minimally invasive cardiac surgery (MICS). Results The mean duration of the surgical procedures was 3.9±1.3 hours, with conventional open-heart surgery requiring an average of 3.6±1.1 hours and minimally invasive cardiac surgery (MICS) procedure 4.2±1.5 hours. No substantial disparities were found in the total length of hospitalization between the two groups, as both conventional (8.2±4.5 days) and MICS (8.7±7.0 days) demonstrated similar duration. Similarly, the total duration of intensive care unit (ICU) stay displayed similarity, with conventional surgery patients staying an average of 3.9±2.8 days and MICS patients of 4.2±4.1 days. The pattern of blood transfusion and fresh-frozen plasma usage revealed higher rates in the conventional valve surgery group comparing to the MICS group. Conclusion Minimally invasive valve surgery, despite slightly longer operative times, resulted in lower blood transfusion requirements and comparable hospitalization and ICU stay.
Collapse
Affiliation(s)
- Nermir Granov
- Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Armin Šljivo
- Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Tarik Selimović
- Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Damir Kurtagić
- Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Kabil
- Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Muhamed Djedović
- Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Arian Abdulkhaliq
- Faculty of Medicine of Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| |
Collapse
|
2
|
Ahmetspahic A, Burazerovic E, Jankovic D, Kujaca E, Rizvanovic H, Omerhodzic I, Sefo H, Granov N. RoboticScope-Assisted Microanastomosis in a Chicken Leg Model. Asian J Neurosurg 2023; 18:782-789. [PMID: 38161617 PMCID: PMC10756782 DOI: 10.1055/s-0043-1776794] [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] [Indexed: 01/03/2024] Open
Abstract
Background Many recent studies show that exoscopes are safe and effective alternatives to operating microscopes (OM). Developments of robotics and automation are present in neurosurgery with the appearance of a newer device such as RoboticScope (RS) exoscope with a digital three-dimensional (3D) image and a head-mounted display. The body of the RS is connected to a six-axis robotic arm that contains two video cameras, and serves as stereovision. This robotic arm allows accurate 3D camera motions over the field of view, giving the user a great degree of freedom in viewpoint selection. The surgeons may specify the direction and speed of the robotic arm using simple head movements when the foot pedal is pressed. Since its development in 2020, the RS has occasionally been used in neurosurgery for a multitude of procedures. Methods This study showcases vessel microanastomosis training on chicken legs using the RS. The aim of this study is to demonstrate the feasibility of the RS without a comparative analysis of the standard OM. The study was conducted in 2023 during a month-long trial period of the device at the Department of Neurosurgery of the Clinical Center of the University of Sarajevo. All procedures including RS-assisted anastomosis were performed by a neurosurgeon in anastomosis training (A.A.) supervised by a senior vascular neurosurgeon (E.B.). For the purpose of the study, we evaluated occlusion time in minutes, bypass patency with iodine, and overall satisfaction of the trainee in terms of light intensity, precision of automatic focus, mobility of the device, ergonomics, and convenience of the helmet. Results Ten RS-assisted microanastomoses were performed by interrupted suturing technique with 10.0 nylon thread. Bypass training included seven "end-to-side," two "end-to-end," and one "side-to-side" microanastomoses. The smallest vessel diameter was 1 mm. Occlusion time improved by training from 50 to 24 minutes, with contrast patency of the anastomoses in all cases without notable leakage of the contrast, except one case. Complete satisfaction of the trainee was achieved in 7 out of 10 cases. During this period, we also performed different RS-assisted surgeries including a single indirect bypass, convexity brain tumor resection, and microdiscectomies. Conclusion RS provides a new concept for microanastomosis training as an alternative or adjunct to the standard microscope. We found a full-time hands-on microsuturing without the need for manual readjustment of the device as an advantage as well as instant depth at automatic zooming and precise transposition of the focus via head movements. However, it takes time to adapt and get used to the digital image. With the evolution of the device helmet's shortcomings, the RS could represent a cutting-edge method in vessel microanastomosis in the future. Nevertheless, this article represents one of the first written reports on microanastomosis training on an animal model with the above-mentioned device.
Collapse
Affiliation(s)
- Adi Ahmetspahic
- Department of Neurosurgery, Clinical Center of the University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
- Department of Medicine, Sarajevo School of Science of Technology., Hrasnicka cesta 3a, Sarajevo, Bosnia and Herzegovina
| | - Eldin Burazerovic
- Department of Neurosurgery, Clinical Center of the University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
| | - Dragan Jankovic
- Department of Neurosurgery, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
- Department of Medicine, Josip Juraj Strossmayer University, Trg Svetog Trojstva3, Osijek, Croatia
| | - Eleonora Kujaca
- Department of Medicine, Sarajevo School of Science of Technology., Hrasnicka cesta 3a, Sarajevo, Bosnia and Herzegovina
| | - Hana Rizvanovic
- Department of Medicine, Sarajevo School of Science of Technology., Hrasnicka cesta 3a, Sarajevo, Bosnia and Herzegovina
| | - Ibrahim Omerhodzic
- Department of Neurosurgery, Clinical Center of the University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
- Department of Medicine, University of Sarajevo, Cekalusa 90, Sarajevo, Bosnia and Herzegovina
| | - Haso Sefo
- Department of Neurosurgery, Clinical Center of the University of Sarajevo, Bolnička 25, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Department of Medicine, University of Sarajevo, Cekalusa 90, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
3
|
Granov N, Šljivo A, Mujičić E, Rebić D, Džubur A, Begić E, Selimović T, Zvizdić Z, Fajkić A, Jonuzi A, Kabil E, Štraus S. Minimally invasive coronary artery bypass (MICS CABG) in Bosnia and Herzegovina: a single centre, single surgeon cohort experience. Med Glas (Zenica) 2023; 20. [PMID: 37300469 DOI: 10.17392/1571-23] [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] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 04/04/2023] [Accepted: 04/07/2023] [Indexed: 06/12/2023]
Abstract
Aim This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery (MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG). Methods This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients with indication for surgical revascularization. Results Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28). Conclusion Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets.
Collapse
Affiliation(s)
- Nermir Granov
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Armin Šljivo
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ermina Mujičić
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Damir Rebić
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alen Džubur
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Begić
- Department of Cardiology, General Hospital "Prim. Dr Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
| | - Tarik Selimović
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zlatan Zvizdić
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Almir Fajkić
- School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Asmir Jonuzi
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Kabil
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Slavenka Štraus
- Clinical Centre University of Sarajevo, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
4
|
Rebić D, Begić E, Šljivo A, Granov N, Hasanspahić S, Džubur A, Durak-Nalbantić A. Lipid status and carotid intima-media thickness in patients with end-stage renal disease. Med Glas (Zenica) 2023; 20. [PMID: 37300463 DOI: 10.17392/1570-23] [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] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/24/2023] [Accepted: 02/10/2023] [Indexed: 06/12/2023]
Abstract
Aim To assess morphological characteristics of carotid blood vessels in uremic patients before to the initiation of the dialysis treatment, and corelate data with various dialysis therapy modules. Methods The study included 30 patients with end-stage renal disease (ERDS) prior to commencing dialysis, 30 patients treated with haemodialysis and 30 patients treated with continuous ambulatory peritoneal dialysis. The control group consisted of 15 subjects with normal kidney function (eGFR>60ml/min). Carotid intima-media thickness (CIMT), as well as lipid status values (cholesterol, triglycerides, low-density lipoprotein (LDL), high-density lipoprotein (HDL), apolipoprotein A, apolipoprotein B) were evaluated. Results The significant difference in CIMT was detected between the control and haemodialysis groups (p<0.001), and between the control and the peritoneal dialysis group (p=0.004). In patients in the predialysis group, CIMT was influenced by cholesterol (p=0.013), HDL (p=0.044), LDL (p=0.001) and ApoB (p=0.042) values. A significant difference in CIMT was proved between the haemodialysis and predialysis group of patients (p<0.001). The only variable from the patient's lipometabolic profile significantly associated with the change in IMT in uremic patients was HDL. A significant difference was found in the average value for systolic blood pressure (p<0.001) and diastolic blood pressure (p=0.018) in patients before starting the dialysis treatment compared to patients treated with other dialysis methods. Conclusion Patients on haemodialysis treatment had a significantly greater CIMT, which is in relation with a higher cardiovascular risk.
Collapse
Affiliation(s)
- Damir Rebić
- Clinic for Nephrology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Begić
- Department of Cardiology, General Hospital "Prim. dr Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina
| | - Armin Šljivo
- Emergency Medical Centre of Canton Sarajevo,Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Senad Hasanspahić
- Clinic for Nephrology, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alen Džubur
- Clinic for Heart, Blood Vessels and Rheumatic diseases, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Durak-Nalbantić
- Clinic for Heart, Blood Vessels and Rheumatic diseases, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
5
|
Karabdic IH, Straus S, Granov N, Hadzimehmedagic A, Berberovic B, Kabil E, Djedovic M, Kurtagic D. Off pump Versus On pump Coronary Artery Bypass Grafting: Short-term Outcomes. Acta Inform Med 2023; 31:107-110. [PMID: 37711485 PMCID: PMC10498367 DOI: 10.5455/aim.2023.31.107-110] [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: 05/05/2023] [Accepted: 06/26/2023] [Indexed: 09/16/2023] Open
Abstract
Background Coronary artery disease (CAD) is a major public health issue and a leading cause of death globally. It is one of the most common indications for surgical intervention. There are a lot of different techniques, including CABG, which consists of two approaches: sternotomy and mini-thoracotomy. Different techniques have been developed to improve surgical outcomes, including the use of machine for extracorporal circulation (on-pump) or without it (off-pump). Objective The objective of this study was to assess whether off-pump CABG offers superior short-term outcomes compared to traditional on-pump CABG in patients undergoing isolated CABG.. Methods In period between 2022 - 2023, we performed CABG operation in 80 patients. CABG was performed either on- pump or off-pump. Results The results have shown advantages and disadvantages of one or another type of CABG. We were comparing the duration of surgical procedure, time on mechanical ventilation, drainage volume, neurological incidents, time to discharge, indication for repeat revascularization and mortality between two groups. Conclusion The choice of surgical technique should be based on individual patient factors, including comorbidities and surgical risks. It is important to say that OPCABG is more challenging than ONCABG, and it is very important that OPCABG is done by skilled, experienced and confident surgeon, which contributes to better outcome and survival.
Collapse
Affiliation(s)
| | - Slavenka Straus
- Clinic for Cardivascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardivascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amel Hadzimehmedagic
- Clinic for Cardivascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Behija Berberovic
- Clinic for Cardivascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Kabil
- Clinic for Cardivascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Muhamed Djedovic
- Clinic for Cardivascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Damir Kurtagic
- Clinic for Cardivascular Surgery, Clinical Center of University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
6
|
Straus S, Karabdic IH, Grabovica S, Hadzimehmedagic A, Djedovic M, Kabil E, Selimovic T, Granov N. How Important Impact of Low Level of Hematocrit Can Be on Outcome in Patients Undergoing Off Pump Coronary Artery Bypass Surgery? Acta Inform Med 2023; 31:102-106. [PMID: 37711492 PMCID: PMC10498362 DOI: 10.5455/aim.2023.31.102-106] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 06/23/2023] [Indexed: 09/16/2023] Open
Abstract
Background Cardiosurgical patients can be often anemic, and preoperative anaemia is associated with increased postoperative complications, as well as morbidity and mortality. Objective The present study was conducted aiming to determine the influence of lower preoperative hematocrit values on the early postoperative recovery of patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). Methods Our retrospective study included 150 patients who underwent elective OPCABG surgery from September 2021 to December 2022 at the Clinic for Cardiovascular Surgery University of Sarajevo. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin level <130g/l males and <120g/l females. Study observed comorbidities and early postoperative data. Results Overall prevalence of anemia in OPCABG patients was 36,6%, more frequent among older patients. Comorbidities as chronic obstructive pulmonary disease, hypertension, ejection fraction was quite similar in both groups, but body mass index was significantly higher in the group of patients with anemia (29.9% vs 28.4%). In early recovery period, vasopressors were more used in patients with anemia (63.6% vs 42.1%) and their doses were higher. Total drainage was higher in patients with anemia (744.45±45.72 ml vs 681.58±349.06 ml). Number of transfusions was higher in the group of patients with anemia: red blood cells (0.89±1.29 vs 0.29±0.84; p<0,05), fresh frozen plasma (0.65±1.13 vs 0.41±1.15; p<0,05) and platelets (0.11±0.57 vs 0,07±0.42; p>0,05). Duration of mechanical ventilation was longer in patients with anemia compared to non-anemic patients (623-91±259.83 minutes vs 469±191.13 minutes). Atrial fibrillation occurred more often in patients with anemia (12.7 vs 7.4%). Length of stay in the intensive care unit was without significant difference. Conclusion Based on our findings, patients who underwent elective OPCABG with lower than normal hematocrit, needed more blood and blood products, more vasopressor drugs in higher doses, longer mechanical ventilation, all which can prolong the patient's recovery and increase the cost of treatment.
Collapse
Affiliation(s)
- Slavenka Straus
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Sanja Grabovica
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amel Hadzimehmedagic
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Muhamed Djedovic
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Kabil
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Tarik Selimovic
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
7
|
Omerhodzic I, Dzurlic A, Rovcanin B, Rotim K, Hadzimehmedagic A, Ahmetspahic A, Zvizdic Z, Granov N, Suljic E. Hinge craniotomy as an alternative technique for patients with refractory intracranial hypertension. Brain Spine 2023; 3:101758. [PMID: 37383443 PMCID: PMC10293230 DOI: 10.1016/j.bas.2023.101758] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/04/2023] [Accepted: 05/10/2023] [Indexed: 06/30/2023]
Abstract
Introduction Decompressive craniectomy (DC) can save brain tissue, but unfortunately it has many limitations and complications. Hinge craniotomy (HC), as less aggressive method seems to be adequate alternative not only to DC but also to conservative treatment. Research question Presentation of the results of modified surgical techniques of cranial decompression and comparing with more and less aggressive medical options. Material and methods A prospective clinical study was conducted during 86 months. Comatose patients who suffered refractory intracranial hypertension (RIH) were treated. Altogether, 137 patients have been evaluated. The final outcome of all patients in the study was evaluated after 6 months. Results Both surgical options resulted in adequate control of intracranial pressure (ICP). HC method was shown to have the lowest probability of worsening from a prior state of relative stability. Discussion and conclusion There was no statistically significant difference between methods to treatment of DC or HC, meaning the final outcome of patients treated in any manner. There was similar rate of early and late complications.
Collapse
Affiliation(s)
- Ibrahim Omerhodzic
- Department of Neurosurgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Almir Dzurlic
- Department of Neurosurgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Bekir Rovcanin
- Department of Neurosurgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Kresimir Rotim
- Department of Neurosurgery, Clinical Hospital Center Sisters of Mercy, Zagreb, Croatia
| | - Amel Hadzimehmedagic
- Department of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Adi Ahmetspahic
- Department of Neurosurgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Zlatan Zvizdic
- Department of Pediatric Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Department of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Enra Suljic
- Department of Neurology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
8
|
Rebić D, Begić E, Aziri B, Džubur A, Gogić E, Durak-Nalbantić A, Hamzić-Mehmedbašić A, Hasanspahić S, Granov N. The Role of Dyslipidemia in Atherogenesis in Peritoneal Dialysis Patients. Adv Biomed Res 2023; 12:135. [PMID: 37434937 PMCID: PMC10331554 DOI: 10.4103/abr.abr_1_23] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 01/29/2023] [Accepted: 02/01/2023] [Indexed: 07/13/2023] Open
Abstract
Background To evaluate atherosclerotic changes in carotid arteries (CCA) in uremic patients before and after 18 months of continuous ambulatory peritoneal dialysis (CAPD) treatment, and to evaluate the impact of dyslipidemia and CAPD treatment on vascular remodeling. Materials and Methods We conducted a longitudinal, prospective study during 2020 and 2021 at the Clinic for Nephrology, Clinical Center University of Sarajevo. Patients with end-stage renal disease were included and were followed during 18 months of CAPD treatment. All patients were treated using commercially prepared biocompatible balanced dialysis solutions. Carotid intima-media thickness (IMT) and atherosclerotic plaques on the common carotid artery (CCA) were measured by echotomography. Results A total of 50 patients were included and were followed during 18 months of CAPD treatment. Lipid values in the serum of patients with CAPD were significantly lower after 18 months of CAPD treatment compared to the values before treatment, while the value of high-density lipoprotein (HDL) was significantly increased after 18 months of CAPD treatment. The values of IMT and the diameter of the CCA compared to the basal values were significantly lower (P < 0.001). Conclusion We demonstrated significantly lower lipid values and higher HDL levels following CAPD treatment. Correct selection of the targeted pharmacological intervention can substantially impact the regression of vascular changes in patients on peritoneal dialysis.
Collapse
Affiliation(s)
- Damir Rebić
- Department for General Nephrology, Clinic for Nephrology, Sarajevo, Bosnia and Herzegovina
| | - Edin Begić
- Department of Cardiology, General Hospital “Prim.Dr. Abdulah Nakaš”, Sarajevo, Bosnia and Herzegovina
- Department of Pharmacology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Buena Aziri
- Department of Pharmacology, School of Medicine, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Alen Džubur
- Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ena Gogić
- Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Durak-Nalbantić
- Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Senad Hasanspahić
- Department for General Nephrology, Clinic for Nephrology, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
9
|
Ahmetspahić A, Janković D, Burazerovic E, Rovčanin B, Šahbaz A, Hasanagić E, Džurlić A, Granov N, Feletti A. Clinical Characteristics of Poor-Grade Aneurysmal Subarachnoid Hemorrhage Treatment. Asian J Neurosurg 2023; 18:132-138. [PMID: 37056885 PMCID: PMC10089758 DOI: 10.1055/s-0043-1764118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Abstract
Background The initial clinical status after aneurysm rupture, whether primary or secondary, determines the final outcome. The most common cause of patient deterioration is a high Hunt and Hess (HH) score, which correlates closely with a high mortality rate. Poor-grade aneurysmal subarachnoid hemorrhage (SAH) is determined as an HH score 4 or 5. The aim of this study was to evaluate the clinical characteristics of poor graded aneurysmal SAH at our institution.
Patients and Methods During the 5-year period, 415 patients with intracranial aneurysm were admitted to our institution. Patients with poor-grade aneurysmal SAH accounted 31.08% (n = 132) of the total number of ruptured aneurysms. Interventional treatment was predominantly in the form of surgery, whereas conservative treatment included medication and external ventricular drainage. Final outcome was assessed with a modified Rankin score (mRs). Statistical analysis was performed using SPSS version 23.0 with a significance level set to 5% (α = 0.05).
Results The majority of patients (57.6%) were in the age range from 51 to 69 years. Twenty-five patients (18.9%) had an HH score of 4, whereas 107 patients (81.1%) had an HH score of 5. Depending on the location, the majority of patients (n = 43) had an aneurysm on the medial cerebral artery (MCA). The final aneurysm occlusion was performed in 71 patients, of whom 94.36% were treated surgically. A positive outcome (mRs 0–4) was found in 49.25% of patients who underwent primarily surgical, treatment with a mortality of 42.3%. Although the outcome was better in patients with an HH score 4, both groups benefited from surgical treatment.
Conclusion Poor-grade aneurismal SAH is a condition of the middle and older age, with most patients with an HH 5 score and deep comatose state. There was better outcome in patients with an HH score of 4 compared to an HH score of 5 and both groups benefited from surgical treatment, which resulted in a positive outcome in almost 50% of surgically treated patients.
Collapse
|
10
|
Berberovic BH, Granov N, Haxhibeqiri-Karabdic I, Hadzimehmedagic A, Berberovic E. Type A aortic dissection during delivery. Int J Gynaecol Obstet 2023. [PMID: 36951626 DOI: 10.1002/ijgo.14755] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Behija Hukeljic Berberovic
- Clinic for Cardiovascular Surgery, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Amel Hadzimehmedagic
- Clinic for Cardiovascular Surgery, Clinical Centre University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edina Berberovic
- Clinic for Women's Diseases and Delivery, University Clinical Hospital Centre Rijeka, Rijeka, Croatia
| |
Collapse
|
11
|
Tahirovic E, Granov N. A Man in His 50s With an Unusual Network of Small Veins in the Left Infraclavicular Region-Paget-Schroetter Syndrome. JAMA Cardiol 2023; 8:404. [PMID: 36753231 DOI: 10.1001/jamacardio.2022.5455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Elnur Tahirovic
- Department for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina.,Faculty of Engineering and Natural Sciences, Department of Genetics and Bioengineering, International Burch University, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Department for Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
12
|
Kabil E, Granov N, Haxibeqiri-Karabdić I, Grabovica S, Mujičić E, Štraus S, Banjanović B, Djedović M. Minimally invasive mini-thoracotomy access as a surgical method in state-of-the-art treatment of single-vessel coronary heart disease. Med Glas (Zenica) 2023; 20. [PMID: 36692987 DOI: 10.17392/1506-22] [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] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/10/2022] [Accepted: 11/07/2022] [Indexed: 01/25/2023]
Abstract
Aim To compare outcomes of two different surgical techniques of coronary artery bypass grafting (CABG) for treating isolated left anterior descending (LAD) coronary artery disease by full median sternotomy technique vs. minimally invasive approach via left anterior mini-thoracotomy. Methods This retrospective, observational study, which included 61 elective patients, was conducted at the Clinic for Cardiovascular Surgery of the Clinical Centre of the University of Sarajevo in the period from June 2019 to January 2022. Patients were divided in two groups according to the operative technique used, the sternotomy CABG group of 30 patients where the access considered full median sternotomy, and the minimally invasive CABG group where left anterior mini-thoracotomy was performed. The groups were compared by previously defined primary and secondary clinical postoperative outcomes. Results Out of 61 patients, the majority was males, 50 (82%). The analysis of the outcomes of the minimally invasive CABG surgery showed significantly shorter operative times (p=0.001), less postoperative drainage (p=0.001) and transfusion requirements, shorter mechanical ventilation duration (p=0.0001), low major adverse cardiac and cerebrovascular events rates, as well as shorter Intensive Care Unit stay days with mean of 3.3±1.442 days (p=0.025), but no total hospital stay days with mean of 6.7±1.832 days (p=0.075) compared to sternotomy CABG group. Conclusion Minimally invasive approach for CABG surgery in treating isolated single vessel LAD disease, together with the fasttrack protocol, offers a reasonable alternative to full median sternotomy, leading to faster patients' overall recovery and improving the quality of life.
Collapse
Affiliation(s)
- Edin Kabil
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ilirijana Haxibeqiri-Karabdić
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Sanja Grabovica
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Ermina Mujičić
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Sarajevo Medical School, Sarajevo School of Science and Technology, Sarajevo, Bosnia and Herzegovina
| | - Slavenka Štraus
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Bedrudin Banjanović
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Muhamed Djedović
- Clinic for Cardiovascular Surgery, University Clinical Center of Sarajevo, Sarajevo, Bosnia and Herzegovina
- School of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
13
|
Begic Z, Begic N, Granov N, Vila H, Berberovic-Hukeljic B, Begic E, Rebic D. Pacemaker implantation in the pediatric population: Bosnian and herzegovinian experience. Heart Mind 2023. [DOI: 10.4103/hm.hm_12_22] [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: 04/05/2023] Open
|
14
|
Šljivo A, Abdulkhaliq A, Granov N, Reiter L, Mahendran E, Zeglis I, Mohammed MA, Yousef A, Dadić I, Ivanović K, Selimović A, Mujičić E, Gabor-Harosa FM. COVID-19 vaccination knowledge, attitudes and practices among the general population of Romania during the third wave of COVID-19 pandemic. SAGE Open Med 2023; 11:20503121231165670. [PMID: 37089469 PMCID: PMC10111160 DOI: 10.1177/20503121231165670] [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: 12/08/2022] [Accepted: 03/05/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Romania began its COVID-19 immunization programme with approved vaccinations in three stages, as follows: The first step of vaccination is for health and social professionals, the second stage is for high-risk persons and the third stage is for the remainder of the general public. This study aims at assessment of knowledge, attitude and practice towards COVID-19 and vaccination against COVID-19 in the Romanian population during the third wave of the pandemic. Methods This cross-sectional study was based on a Bosnian and Herzegovinian study on COVID-19 vaccination during the country's third wave of COVID-19 pandemic. Results Our study sample, dominantly female (629; 61.0%), with a bachelor's degree (734; 71.2%), either single (539; 52.3%) or in a relationship (363; 35.2%), engaged in intellectual labour (910; 88.3%) and living in an urban environment (874; 84.8%) with a mean age of 25.07 ± 8.21 years, 294 (28.5%) people with COVID-19 symptoms and 86 (8.3%) were tested COVID-19 positive, had a mean knowledge score of 16.38 ± 4.0 with correct answer rates on questions ranging from 30.1% to 88.2%. Being single (odds ratio = 3.92, p = 0.029) or in a relationship (odds ratio = 3.79, p = 0.034), having a bachelor's degree and higher (odds ratio = 1.61, p = 0.006) and being COVID-19 tested (odds ratio = 1.82, p < 0.001) were associated with higher knowledge test scores. Our sample had relatively optimistic attitudes towards final COVID-19 disease containment (712; 69.1%) and vaccination programmes (679; 65.9%). The majority of the sample followed socio-epidemiological measures and did not visit places of mass social gatherings (666; 64.1%) and wore masks (992; 95.7%) while being outside their home. In terms of vaccination rates, 382 (37.0%) of the individuals were presently immunized against COVID-19. Higher knowledge test scores (>15 points) (odds ratio = 1.66, p = 0.002) and positive attitudes of this study (odds ratio = 1.59, p = 0.001, odds ratio = 4.16, p < 0.001) were identified as independent predictors for vaccinating against COVID-19. Conclusion Romanian citizens have had good knowledge, optimistic attitudes and appropriate practices towards COVID-19 vaccination during the third wave of COVID-19 outbreak in the country. Higher knowledge regarding the disease and vaccination against it not only increased attitudes towards the end of the pandemic, but also increased the willingness to be vaccinated and to avoid infection risk factors.
Collapse
Affiliation(s)
- Armin Šljivo
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
- Armin Šljivo, Clinical Center University of
Sarajevo, University of Sarajevo, Emergency Medical Service of Canton Sarajevo,
Kolodvorska 14, Sarajevo 71 000, Bosnia and Herzegovina.
| | - Arian Abdulkhaliq
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Nermir Granov
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Leopold Reiter
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Eljakim Mahendran
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ioannis Zeglis
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | | | - Assy Yousef
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| | - Ilma Dadić
- Faculty of Medicine, University of
Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Amina Selimović
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ermina Mujičić
- Clinical Center University of Sarajevo,
University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Florina Maria Gabor-Harosa
- Faculty of Medicine, Iuliu Haţieganu
University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Romania
| |
Collapse
|
15
|
Banjanovic B, Karabic IH, Straus S, Granov N, Kabil E, Jakirlic M, Pilav I, Djedovic M. Non Invasive Detection of Coronary Sinus Flow Changes Over Time After CABG. Acta Inform Med 2022; 30:220-224. [PMID: 36311157 PMCID: PMC9559649 DOI: 10.5455/aim.2022.30.220-224] [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: 07/10/2022] [Accepted: 08/14/2022] [Indexed: 01/09/2023] Open
Abstract
Background Coronary New blood in the vascular bed after Coronary Artery Bypass Grafting (CABG) may represent a turning point between ischemia and normal tissue nutrition. Its quantification can help to better understand coronary artery hemodynamics after revascularization. Objective Quantification of coronary sinus blood flow changes over time after Coronary Artery Bypass Grafting (CABG) using Transthoracic Echocardiography (TTE). Methods Prospective basic research, with repeated measurements on hospital sample of 61 patients whom CABG was conducted. We performed TTE recordings to measure CS flow before and two times after CABG (1 and 6 postoperative day). We measure CS diameter, Velocity Time Integral (VTI) and systemic hemodynamic data. Data needed for LV mass calculation were recorded once. During statistical analysis we define: α = 0,01, β = 0,01 (power = 1-β β= 0,99), Sample size = 60, Effect size= 0,68. We used ANOVA for Repeated Measures as main statistical test in SPSS. Results Preoperatively we found low overall CS flow of 181 ±72 ml/min (0,68 ±0,30 ml/gram-LV/min). After surgery there was constant increase of CS flow from 276 ±79 ml/min (1,13 ±0,35 ml/gram-LV/min) first postoperative day, to 355 (±99) ml/min (1,30 ±0,46 ml/gram-LV/min) sixth postoperative day. Discussion Amount of new blood was statistically significant after CABG with P<0,001. Same result was found after classifying patients per number of graft received, with the highest amount of new blood after four bypasses. Amount of new blood was not different if patient gets two or three bypasses. Conclusion There was significantly new amount of blood in coronary bed after CABG, with constant increase over first 6 days.
Collapse
Affiliation(s)
- Bedrudin Banjanovic
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | | | - Slavenka Straus
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Edin Kabil
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Malik Jakirlic
- Clinic for Plastic and Reconstructive Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Ilijaz Pilav
- Clinic for Thoracic Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| | - Muhamed Djedovic
- Clinic for Cardiovascular Surgery, Clinical Center University of Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
16
|
Djedovic M, Hadzimehmedagic A, Granov N, Haxhibeqiri-Karabdic I, Štraus S, Banjanovic B, Kabil E, Selimovic T. The Effect of Severe Contralateral Carotid Stenosis or Occlusion on Early Outcomes after Carotid Endarterectomy. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.9475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Stenosis of the carotid arteries, as a consequence of atherosclerosis is the most common cause of cerebrovascular insult (CVI). Severe (>70%) contralateral stenosis or occlusion (SCSO) of the carotid artery may represent an additional pre-operative risk factor for neurologic incidents.
AIM: The aim of this study was to confirm and compare early perioperative results (0-30 days) of carotid endarterectomy (CEA) in patients with and without SCSO.
PATIENT AND METHODS: In our retrospective-prospective study, we analysed the results of 273 CEA, divided into two groups based on the presence of significant contralateral stenosis or occlusion (non-SCSO and SCSO groups)
RESULTS: 273 CEA’s were performed, divided into two groups: SCSO groups 40 (14.7%) and non-SCSO group 233 (85.3%). Between the two groups, a statistically significant difference between patients was found (54.1% compared to 87.5%; p<0.0005), CEA with patch angioplasty (25.3% compared to 52.5%; p=0.001), and CEA with the use of a shunt (3.9% compared to 35%; p<0.0005) in favour of the SCSO group. There was no statistically significant difference (SCSO was not identified as a risk factor) for any type of stroke or mortality. Logistically regression confirmed SCSO to be an independent predictor of 30-day mortality (OR 21.58; 95% CI 1.27-36.3; p= 0.033) and any type of stroke or mortality (OR 9.27; 95% CI 1.61-53.22; p= 0.012). SCSO was not a predictor of any type of stroke within 30 days. Predictors of any type of stroke was dyslipidemia (OR 0.12, 95% CI 0.02-0.76; p= 0.024).
CONCLUSIONS: There was no statistically significant difference in the incidence of early (30 day) perioperative complications between the analysed groups. The percentage of perioperative complications remains within the accepted parameters, and thus, SCSO should not be qualified as a significant risk factor for CEA. We are of the opinion that CEA remains a safe and acceptable options for patients with SCSO, and SCSO should not be a reason for preferential use of carotid stenting.
Collapse
|
17
|
Karic A, Haxhibeqiri-Karabdic I, Kabil E, Grabovica S, Straus S, Busevac E, Krajinovic A, Banjanovic B, Djedovic M, Granov N. Left Ventricular Free Wall Rupture After Acute Myocardial Reinfarction Due to In-Stent Thrombosis in COVID-19 Patient. Acta Inform Med 2022; 30:76-80. [PMID: 35800909 PMCID: PMC9226759 DOI: 10.5455/aim.2022.30.76-80] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/10/2022] [Indexed: 11/27/2022] Open
Abstract
Background: Acute left ventricular free wall rupture (LVFWR) is a life-threatening complication of myocardial infarction that requires urgent intervention. Surgical repair has continued to be the treatment of choice. Studies suggest a posterolateral or inferior infarction is more likely to result in free wall rupture than an anterior infarction. LVFWR generally results in death within minutes of the onset of recurrent chest pain, and on average was associated with a median survival time of 8 hours. Prompt diagnosis and management can lead to successful treatment for LVFWR. Objective: The aim of this article was to present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Case report: We present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Although dual antiplatelet therapy introduction and good outcome of PCI were achieved, soon after instant thrombosis of both stents appear to result in transmural necrosis and LVFWR. Urgent catheterization was performed and diagnosed in-stent thrombosis where the ventriculography confirmed LVFWR of the posteroinferior wall. Urgent surgery was performed. Transmural necrosis was noticed alongside the incision line. The incision is sawn with 4 U-stitches (Prolen 2.0 with Teflon buttressed stitches). Another layer of fixation was made by Prolen 2.0 running stitches reinforced with Teflon felts from both sides. A large PTFE patch was fixed to epicardium over the suture line by Prolen 6.0 running stitch and BioGlue was injected in-between patch and LV (Figures 8 and 9). After aortic cross-clamp removal, the sinus rhythm was restored. Conclusion: Despite the high mortality, the urgency and the complexity of surgical treatment the early diagnosis plays a key role in the management of postinfarction LVFWR patients presenting a case of preserved postoperative left ventricular function and accomplished good functional status, as presented in our case.
Collapse
Affiliation(s)
- Alen Karic
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Edin Kabil
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sanja Grabovica
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Slavenka Straus
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Ervin Busevac
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Alma Krajinovic
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Bedrudin Banjanovic
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Muhamed Djedovic
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
18
|
Tahirovie E, Granov N, Granov-Grabovica S, Haxhibeqiri-Karabdić I, Hadžimehmedagić A. Massive hemothorax due to perforation of the left ventricular apex with the right ventricular lead. Heart Views 2022; 23:190-191. [DOI: 10.4103/heartviews.heartviews_29_22] [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] [Received: 03/26/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022] Open
|
19
|
Banjanovic B, Karabdic IH, Straus S, Berberovic BH, Djedovic M, Granov N. Deep Sternal Wound Infection After Open-heart Cardiac Surgery and Vacuum-Assisted Closure Therapy: a Single-center Study. Med Arch 2022; 76:273-277. [PMID: 36313952 PMCID: PMC9560003 DOI: 10.5455/medarh.2022.76.273-277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/14/2022] [Indexed: 11/23/2022] Open
Abstract
Background: Despite many advances in the prevention, of sternal wound infection, especially deep ones, cardiac surgery with median sternotomy, still presents a significant postoperative complication. Numerous operative and non-operative procedures should be used in treatment, there is a prolonged hospital stay and increased hospital costs treating this postoperative complication. Objective: The present study was conducted aiming to determine the incidences, and risk factors, identify microbiology findings, and antibiotic therapy among patients with DSWI who underwent cardiac surgery with median sternotomy at our Clinic and VAC treatment. Methods: This retrospective observational study was conducted in Clinic for Cardiovascular Surgery at University Clinical Center Sarajevo from November 2015 to November 2020. The data were obtained from 15 patients with deep sternal wound infection (DSWI) following open-heart surgery. The inclusion criteria were DSWI after cardiac operation via median sternotomy, and complete results of microbiological findings obtained by sternal swab. The exclusion criteria were patients with incomplete clinical data. Results: We found that 9 (60%) patients were males and 6 (40%) were females. Coronary artery bypass grafting (CABG) operation had 11 (73,3%) patients, CABG with aortic valve replacement 2 (13,3%), valve replacement surgery operations (13,3%). The average age was 66 years. All patients were elective surgery patients. STS score in the Non-VAC group was 22.6, in the VAC group 16.6, and the average was 14.9. The number of patients with DSWI represents 1% of all sternotomy patients in the observed period. Two risk factors for DSWI had 37% of patients, 25% of them were diabetic, and 3 (9%) were overweight. Enterococcus faecalis was isolated predominantly in 6 (27%) patients, followed by Klebsiella pneumonia 3 (13%), Proteus mirabilis 2 (9%), and Serratia Maecenas 2 (9%). The mortality rate was 33.3% (5 of 15). Conclusion: The results of our study present our experience with DSWI treatment after open-heart surgery. What comes from our experience so far, is that is very important to determine patients who are at risk of developing DSWI after cardiac surgeries to lower its incidence.
Collapse
Affiliation(s)
- Bedrudin Banjanovic
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Bosnia, and Herzegovina
| | | | - Slavenka Straus
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Bosnia, and Herzegovina
| | | | - Muhamed Djedovic
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Bosnia, and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Bosnia, and Herzegovina
| |
Collapse
|
20
|
Djedovic M, Hadzimehmedagic A, Rustempasic N, Granov N, Haxhibeqiri-Karabdic I. The Impact of Unilateral and Bilateral Eversion Carotid Endarterectomy on Postoperative Hemodynamic Parameters. Med Arch 2021; 75:194-198. [PMID: 34483449 PMCID: PMC8385746 DOI: 10.5455/medarh.2021.75.194-198] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/20/2021] [Indexed: 11/07/2022] Open
Abstract
Background: Carotid endarterectomy (CEA) is an effective and safe treatment of stenosed carotid arteries, and is a preventive operation with well-defined indications. It is associated with a loss of the baroreceptor reflex and postoperatively increased hemodynamic parameters. Objective: The aim of the study was to confirm the sensitivity of baroreceptors and the impact on arterial pressure and heart rate in unilateral and bilateral eversion carotid endarterectomies. Methods: A retrospective study was conducted with 30 patients treated with E-CEA in local anesthesia at the Clinic for cardiovascular surgery from December 2019 to May 2021, due to stenosis of the carotid arteries. Patients were divided into two groups: 15 patients in group A (patients with unilateral E-CEA; 15 patients in group B: patients with bilateral E-CEA). Results: Out of the total of 30 patients included in the research, 15 patients in groups A and B respectively, there were no statistically significant differences in regards to gender (p= 0,245) and preoperative risk factors: smoking (p=0,449); hypertension (p=0,388); diabetes (p= 0,714); hyperlipidemia (p=0.388), coronary disease (p=0.461) and symptomatic stenosis of the carotid arteries (p=0.449). Noted were the statistically significant differences in values of systolic and diastolic pressure on the 3rd postoperative days in patients with bilateral E-CEA (p=0,001; p=0,001), a statistically significant difference in the heart rate was not found in the analyzed groups in the postoperative period (p=0,225; p=0,994). Conclusion: This study identified statistically significant differences in values of systolic and diastolic pressure in the early postoperative period. In his period, early detection and correction of these hemodynamic disorders are needed.
Collapse
Affiliation(s)
- Muhamed Djedovic
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Amel Hadzimehmedagic
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nedzad Rustempasic
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic of Cardiovascular Surgery, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | |
Collapse
|
21
|
Abstract
Introduction Excess dilatation of the left atrium >65 mm is known in the literature as gigantic atrium. This dilation is most commonly encountered in the mitral insufficiency of rheumatic etiology, but also in severe prolapses of the mitral valve, permanent atrial fibrillation, and at the left right shunt with cardiac insufficiency. Case report In this paper is presented a case study of echocardiographically verified giant thrombus in left atrium in a 50 years old female patient aged 50 hospitalized because of tiredness, choking, heartburn and urinary tract symptoms. The patient had rheumatic fever at age of 18 years. At age of 35, she was diagnosed with mitral stenosis. In permanent atrial fibrillation with anamnestic data on the previous cerebrovascular stroke (CVI) and the repeated transitional ischemic seizures. Echocardiographic examination confirmed severe mitral stenosis with moderate aortic insufficiency and gigantic left atrium (LA) with gigantic thrombus. Invasive diagnostics were indicated and performed, followed by an acute cardiac surgery including left atrial thrombectomy and implantation of the mechanical aortic and mitral valve. The surgical course was without complications. Conclusion On eleven postoperative day, after mobilization, the patient experiences stroke with motor aphasia. She was clinically recovering from stroke consequences, and remains cardiollogically stable.
Collapse
Affiliation(s)
- Enisa Hodzic
- Clinic for Heart, Blood Vessel and Rheumatic Diseases. University Clinical Center Sarajevo, Rajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
22
|
Straus S, Haxhibeqiri-Karabdic I, Grabovica SG, Granov N. A Difference in Bleeding and Use of Blood and Blood Products in Patients who Were Preoperatively on Aspirin or Dual Antiplatelet Therapy Before Coronary Artery Bypass Grafting. Med Arch 2018; 72:31-35. [PMID: 29416215 PMCID: PMC5789565 DOI: 10.5455/medarh.2018.72.31-35] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Postoperative bleeding in patients who underwent elective coronary artery bypass surgery (CABG) may increase due to preoperative anticoagulant therapy indicative of their disease - acute coronary syndrome or implanted coronary artery stent. Increased bleeding in many cases requires the use of blood and blood derivatives, and sometimes even reoperation. Their use poses the risk of complications, may extend the hospitalization. Methods Our observation retrospective study included 131 patients, 41 treated with aspirin and 90 treated with aspirin and clopidogrel. All underwent for the first time elective on-pump isolated CABG surgery at Clinic for cardiovascular surgery of Clinical Center University of Sarajevo, in period June 2016 to September 2017. The data were collected from patient's records. Results Out of 131 patients,73.3% were male. The average age was 62. The average total drainage during the first 48 postoperative hours in ASA group was 1027.4±404.9ml and 1049.8±371.3ml in DAPT group. The mean number of whole blood transfusions in the DAPT group washigher compared to ASAgroup. The average number of fresh frozen plasma were higher in the DAPT group 0.84±0.51 compared to the group ASA 0.39±0.07, as well the average thrombocytes transfusions were slightly higher in the DAPT group. Statistical analysis suggests that there is no significant difference between the observed groups (p>0.05). Also, our study did not show a statistically significant difference between arrhythmia onset, the length of mechanical ventilation, use of protamineand tranexamic acid. Reoperation due to postoperative bleeding was recorded in 2 cases in the DAPT group as well as 2 lethal cases. Conclusion In our study, we could not demonstrate less postoperative bleeding and use of blood and blood products in a group of patients who were preoperatively treated with aspirin compared to patients with dual antiplatelet therapy in the elective isolated CABG surgery.
Collapse
Affiliation(s)
- Slavenka Straus
- Clinic for Cardiovascular surgery, Department of Cardiac Anesthesia and Intensive Care, University Clinical Center Sarajevo, Sarajevo, Bosnia and Hercegovina
| | | | - Sanja Granov Grabovica
- Clinic for Cardiovascular surgery, Department of Cardiac Anesthesia and Intensive Care, University Clinical Center Sarajevo, Sarajevo, Bosnia and Hercegovina
| | - Nermir Granov
- Clinic for Cardiovascular Surgery, University Clinical Center Sarajevo, Sarajevo, Bosnia and Hercegovina
| |
Collapse
|
23
|
Straus S, HaxhibeqiriKarabdic I, Grabovica S, Granov N, Hadzimehmedagic A. Is There a Difference in Postoperative New-Onset Atrial Fibrillation Following On-Pump Versus Off-Pump Coronary Artery Bypass Graft Surgery? Med Arch 2018. [DOI: 10.5455/medarh.2018.72.99-102] [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: 11/03/2022] Open
|
24
|
Kurtovic-Kozaric A, Vranic S, Kurtovic S, Hasic A, Kozaric M, Granov N, Ceric T. Lack of Access to Targeted Cancer Treatment Modalities in the Developing World in the Era of Precision Medicine: Real-Life Lessons From Bosnia. J Glob Oncol 2017; 4:1-5. [PMID: 30241174 PMCID: PMC6180810 DOI: 10.1200/jgo.2016.008698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Affiliation(s)
- Amina Kurtovic-Kozaric
- Amina Kurtovic-Kozaric, Semir Vranic, Sabira Kurtovic, Mirza Kozaric, Nermir Granov, and Timur Ceric, Clinical Center of the University of Sarajevo; Amina Kurtovic-Kozaric, Semir Vranic, Nermir Granov, Timur Ceric and Azra Hasic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- Amina Kurtovic-Kozaric, Semir Vranic, Sabira Kurtovic, Mirza Kozaric, Nermir Granov, and Timur Ceric, Clinical Center of the University of Sarajevo; Amina Kurtovic-Kozaric, Semir Vranic, Nermir Granov, Timur Ceric and Azra Hasic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Sabira Kurtovic
- Amina Kurtovic-Kozaric, Semir Vranic, Sabira Kurtovic, Mirza Kozaric, Nermir Granov, and Timur Ceric, Clinical Center of the University of Sarajevo; Amina Kurtovic-Kozaric, Semir Vranic, Nermir Granov, Timur Ceric and Azra Hasic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Azra Hasic
- Amina Kurtovic-Kozaric, Semir Vranic, Sabira Kurtovic, Mirza Kozaric, Nermir Granov, and Timur Ceric, Clinical Center of the University of Sarajevo; Amina Kurtovic-Kozaric, Semir Vranic, Nermir Granov, Timur Ceric and Azra Hasic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Mirza Kozaric
- Amina Kurtovic-Kozaric, Semir Vranic, Sabira Kurtovic, Mirza Kozaric, Nermir Granov, and Timur Ceric, Clinical Center of the University of Sarajevo; Amina Kurtovic-Kozaric, Semir Vranic, Nermir Granov, Timur Ceric and Azra Hasic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Amina Kurtovic-Kozaric, Semir Vranic, Sabira Kurtovic, Mirza Kozaric, Nermir Granov, and Timur Ceric, Clinical Center of the University of Sarajevo; Amina Kurtovic-Kozaric, Semir Vranic, Nermir Granov, Timur Ceric and Azra Hasic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Timur Ceric
- Amina Kurtovic-Kozaric, Semir Vranic, Sabira Kurtovic, Mirza Kozaric, Nermir Granov, and Timur Ceric, Clinical Center of the University of Sarajevo; Amina Kurtovic-Kozaric, Semir Vranic, Nermir Granov, Timur Ceric and Azra Hasic, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
25
|
Abstract
Aim: The aim of this study was to examine the impact of antibiotic consumption on development of antimicrobial resistance in Acinetobacter baumannii. Material and Methods: The study was conducted in University Clinical Center of Sarajevo. In our retrospective study Acinetobacter baumannii isolated in period from July 1st 2009 to December 31st 2012. Isolates were detected from different clinical samples including urine, wound swab, blood, bronchial aspirate and other samples which were collected from patients situated on various hospital wards. Clinical isolates belonged to one per patient in a given period of time. Results: Antimicrobial resistance was interpreted according to CLSI breakpoints. Consumption of antibiotics was analyzed according to recommendations of the ESAC-Net and current Acinetobacter baumannii classification. Pearson’s correlation showed a positive correlation between gentamicin consumption and emerging of resistance (p = 0.023). Conclusion: Increase in the antimicrobial use was followed with an increase in resistance of Acinetobacter baumannii isolates. Monitoring of antibiotic resistance and consumption is of a great importance in order to reduce the emergence and spread of antimicrobial resistant organisms in the health care settings.
Collapse
Affiliation(s)
- Djana Granov
- Clinical Microbiology, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | | | - Svjetlana Loga Zec
- Department of Pharmacology, Clinical Pharmacology and Toxicology, Faculty of Medicine University of Sarajevo, Bosnia and Herzegovina
| | - Nermir Granov
- Clinic for Cardio Surgery, University Clinical Center Sarajevo, Bosnia and Herzegovina
| | - Mirsada Hukic
- Institute for Biomedical Diagnostics and Research-Nalaz, Sarajevo, Bosnia and Herzegovina and International Burch University, Sarajevo, Bosnia and Herzegovina
| |
Collapse
|
26
|
Mujicic E, Kevric E, Rasic S, Selimovic A, Granov N, Music D. Contrast Media Injector Technology - Renal Safety During Coronarography. Acta Inform Med 2015; 23:273-5. [PMID: 26635433 PMCID: PMC4639354 DOI: 10.5455/aim.2015.23.273-275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 09/03/2015] [Accepted: 10/05/2015] [Indexed: 11/12/2022] Open
Abstract
Aim: This study sought to assess whether the volume and osmolarity of contrast media (CM) influences the occurrence of contrast induced nephropathy (CIN) following coronarography procedure. CIN can be defined as an increase in the serum concentration of creatinine greater than a 25% from baseline during the period of 12 to 48 hours after the administration of radiocontrast media. Material and methods: We examined 100 patients without diabetes with serum creatinine concentration from 45 mmol/l to 141 mmol/l and 100 patients with diabetes with serum creatinine concentration from 46 mmol/l to 161 mmol/l who underwent coronary angiography. During procedure they received iso-osmolar contrast medium, Visipaque 320 (iodixanol-320), for group without diabetes from 40 to 340 ml and for group with diabetes from 49 to 310 ml. Results: CIN occurred in 27 (13,5%) of the 200 study patients. There was a trend toward higher prevalence of CIN (16% vs.11%, p = 0.086) in the diabetic group compared with the non-diabetic group. Patient with diabetes received less contrast media, they are younger but number patients with CIN are higher.
Conclusion: Increasing contrast media dose is associated with the occurrence of CIN following coronarography. But, another risk factors like diabetes mellitus, old age, male sex and preexisting kidney disease have influence of developing CIN after coronarography.
Collapse
Affiliation(s)
- Ermina Mujicic
- Institute for Heart, Clinical Center of University of Sarajevo, Sarajevo Bosnia and Herzegovina
| | - Ekrem Kevric
- Institute for Heart, Clinical Center of University of Sarajevo, Sarajevo Bosnia and Herzegovina
| | - Senija Rasic
- Nephrology Clinic, Clinical Center of University of Sarajevo, Sarajevo Bosnia and Herzegovina
| | - Amina Selimovic
- Paediatric Clinic, Clinical Center of University of Sarajevo, Sarajevo Bosnia and Herzegovina
| | - Nermir Granov
- Institute for Heart, Clinical Center of University of Sarajevo, Sarajevo Bosnia and Herzegovina
| | - Dinka Music
- Institute for Heart, Clinical Center of University of Sarajevo, Sarajevo Bosnia and Herzegovina
| |
Collapse
|
27
|
Hadžimehmedagić A, Gavrankapetanović I, Vranić H, Šunje M, Gavrankapetanović F, Papović A, Granov N, Begović B, Omerović Đ. Haemodynamic assessment in simulated operative positions before knee arthroplasty can be useful in deep vein thrombosis prediction. Int Orthop 2015; 39:1793-6. [PMID: 26150333 DOI: 10.1007/s00264-015-2837-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 05/15/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE During knee arthroplasty, the leg is placed in several forced positions, which are mainly uncomfortable for all tissue structures in the region, including the vascular structures. Veins have a weaker quality of the wall structure than arteries, so during the forced position morphological and haemodynamic consequences are expected mainly in the venous system. Conditions of safe aseptic environment for the arthroplasty are in collision with routine intra-operative analysis of local haemodynamics in real time. This is the reason why we have no insight into the haemodynamic and morphological changes at the time in which the initiation of deep vein thrombosis (DVT) occurs. For this reason we created the hypothesis that the monitoring of the occurrence and detection of potential DVT risks can be achieved pre-operatively using echosonograms in simulated operative positions, and then compare them with the cases of postoperative DVT. METHODS This research was conducted as a prospective, analytical, minimally manipulative and observational clinical study in the period January 2011 to October 2013. In the preoperative period we made ultrasound and colour-Doppler examinations of deep veins in simulated operative position (full extension 0°, semiflexion 30-60°, flexion 90° and maximal flexion 90°+). The target vein was the posterior tibial vein in the distal third of calf. During the operation we took a note of anaesthesia duration and forced positions duration. After the operation we were looking for ultrasound signs of DVT in a follow-up period of six weeks. The sample was made from 91 patients selected for knee arthroplasty: 56 women and 35 men patients of average age 67.46 years. The oldest patient was 81, and the youngest 48. Average body mass index was 26.98 (±2.20) kg/m(2). After initial ultrasound, the sample was divided into two groups according to vein flow velocity. Patients who had a flow velocity lower than 10 cm/s in any of the forced positions were in the investigated group (N-b, n = 38), and patients who had more favourable haemodynamics in forced positions were in the control group (N-a, n = 53). Patients underwent arthroplasty without tourniquet, and the operative, postoperative and anaesthesiological protocol was the same for all the patients. RESULTS Friedman's test results point out significant differences of posterior tibial vein flow velocity in four simulated positions (0°, 30-60°, 90°, 90°+). Overview of the median value of the posterior tibial vein flow velocity points out reduction of the posterior tibial vein flow velocity in the third and fourth simulated positions. Average range values were lowest in simulated position 90°+. Relative risk for the DVT occurrence was 21.6% higher in the group of patients with flow velocity lower than 10 cm/s with statistical significance. The incidence of DVT was higher in women (22.85%) than in men (14.28%). There was one (1.09%) case of pulmonary embolism (PE) presented as segmental PE. CONCLUSIONS We believe that preoperative ultrasound analysis performed during the simulation of operative positions is a useful pre-operative test that can identify patients at risk of developing postoperative DVT. We would recommend that during surgery procedure to minimise forced position of knee flexion.
Collapse
Affiliation(s)
- Amel Hadžimehmedagić
- Heart Centre, Clinical Centre of the University of Sarajevo, Sarajebo, Bosnia and Herzegovina
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Abstract
As patients and their physicians become more demanding, the desire to make the procedures "minimally invasive" is growing constantly. In short, "minimally invasive" is a code phrase for life saving procedures which in same time disrupt our quality of life the least. Its goals include reducing incision size, decreasing surgical trauma and pain, and improving cosmesits, patient satisfaction, and recovery times. However, the most important goal of minimally invasive aortic valve surgery must be to maintain or improve the efficacy and safety of conventional aortic valve surgery. In this report we would like to present operative technique of minimally invasive aortic valve replacement (MIAVR) we use in our hospital.
Collapse
Affiliation(s)
- Nermir Granov
- Heart Center, Clinical University Center Sarajevo, Bosnia and Herzegovina.
| | | | | | | | | | | |
Collapse
|
29
|
Kulic M, Tahirovic E, Sosevic A, Mujicic E, Granov N, Gorani D, Spuzic M. Prolonged spasm of the left anterior descending coronary artery. Med Arch 2012; 66:209-10. [PMID: 22822627 DOI: 10.5455/medarh.2012.66.209-210] [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: 11/03/2022] Open
Abstract
Coronary artery spasm is one of the well-known causes of anginal chest pain. We presented the case of prolonged spasm of the left anterior descending coronary artery which happened during coronary angiography leading to pulse less state and low blood pressure with syncope and appearing of ventricular fibrillation on ECG. During one hour of successful cardiopulmonary resuscitation, the patient had again normal pulse and blood pressure. Coronary angiography performed immediately after DC's showed normal coronary angiogram. After two days the patient left the hospital without brain disorders.
Collapse
Affiliation(s)
- Mehmed Kulic
- Heart Center, Clinical Center University of Sarajevo, Bosnia and Herzegovina.
| | | | | | | | | | | | | |
Collapse
|
30
|
Granov N, Kacila M, Solinas M, Glauber M. Minimally Invasive Mitral Valve Surgery Through Right Lateral Minithoracotomy - Early Experience of Clinical Centre of University of Sarajevo. Med Arch 2012; 66:357-8. [DOI: 10.5455/medarh.2012.66.357-358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
31
|
Tiwari KK, Granov N, Bevilacqua S, Glauber M. Could effect of smoking guide us to a new treatment option for atrial fibrillation? Interact Cardiovasc Thorac Surg 2010; 11:555. [DOI: 10.1510/icvts.2010.242586a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
32
|
Kacila M, K Tiwari K, Granov N, Omerbasić E, Straus S. Assessment of the Initial and Modified Parsonnet score in mortality prediction of the patients operated in the Sarajevo Heart center. Bosn J Basic Med Sci 2010; 10:165-8. [PMID: 20507299 DOI: 10.17305/bjbms.2010.2717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study has been conducted in an effort to establish more suitable and accurate scoring model we use in everyday practice. Among the specific outcome prediction models, in 1989 Parsonnet et al elaborated a method of uniform risk stratification for evaluation of the results of cardiac surgery procedures. We have tested two forms of the Parsonnet score, Initial and Modified Parsonnet score, in our patients. In the first half of the year 2007, 145 patients were operated in Sarajevo Heart center. All operated patients in that period, have participated in this study. The overall hospital mortality was 4,13 (6 deaths). This study shows that the initial and modified Parsonnet's scores are predictive for operative mortality in adult cardiac surgery patients.
Collapse
Affiliation(s)
- Mirsad Kacila
- Heart Center Sarajevo, University of Sarajevo Clinics Centre, Bolnicka 25, Sarajevo, Bosnia and Herzegovina
| | | | | | | | | |
Collapse
|
33
|
Tiwari KK, Kacila M, Granov N, Glauber M. eComment: Rationalizing the use of assisted venous drainage during minimally invasive valve surgery. Interact Cardiovasc Thorac Surg 2010; 10:871. [PMID: 20479069 DOI: 10.1510/icvts.2009.230888a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kaushal K Tiwari
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Via Aurelia Sud, 54100 Massa, Italy
| | | | | | | |
Collapse
|
34
|
Tiwari KK, Granov N, Bevilacqua S, Glauber M. eComment: does coma state really stop from operating type A aortic dissection patients? Interact Cardiovasc Thorac Surg 2010; 10:841-2. [PMID: 20403996 DOI: 10.1510/icvts.2009.228908a] [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: 11/06/2022] Open
Affiliation(s)
- Kaushal K Tiwari
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy
| | | | | | | |
Collapse
|
35
|
Tiwari KK, Granov N, Ferrarini M, Glauber M. eComment: use of blower in off-pump coronary artery bypass grafting is challenged! Interact Cardiovasc Thorac Surg 2010; 10:769; discussion 769. [PMID: 20403988 DOI: 10.1510/icvts.2009.228270a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kaushal K Tiwari
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Via Aurelia Sud, Massa, Italy
| | | | | | | |
Collapse
|
36
|
Karimov JH, Tiwari KK, Granov N, Glauber M. eComment: treatment of patients with combined coronary and carotid artery disease. Interact Cardiovasc Thorac Surg 2010; 10:827. [PMID: 20403994 DOI: 10.1510/icvts.2009.224162a] [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: 11/06/2022] Open
Affiliation(s)
- Jamshid H Karimov
- Adult Cardiac Surgery, Fondazione G. Monasterio Heart Hospital, Via Aurelia Sud, 54100 Massa, Italy
| | | | | | | |
Collapse
|
37
|
Kacila M, Granov N, Omerbasić E, Memisević N. [Additive and logistic EuroSCORE in assessment of operative mortality in cardiac surgery]. Med Arh 2008; 62:298-299. [PMID: 19469275] [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
INTRODUCTION Patients benefit, reduction of treatment costs, as well as providing data needed for the science progress, are only some of the items that implicate the importance of preoperative evaluation of operative risk and mortality. In order to determine the risk profile of adult cardiac patients and identify the mortality in different procedures, a set of multicentric clinical studies has been carried out in the past decade. A study involving 19030 patients in 128 centers from 8 European countries was conducted at the end of 1995. Product of that study is EuroSCORE (European System for Cardiac Operative Risk Evaluation). PATIENTS AND METHODS In this survey we will point out the results of two different EuroSCORE forms (Additive and Logistic) which we applied in 145 cases of patients operated in Sarajevo Heart Center in the first half-year of 2007. RESULTS From 145 procedures 124 (85%) was bypass procedures, 18 (12.4%) valvular and 3 (2,6%) other procedures (dissection of AA, mixoma LA). CONCLUSION Aditive EuroSCORE model is use friendly and simple for bedside use. In mortality prediction Logistic EuroSCORE is more sensitive (exclude mortality in larger patient groups), and is also more precise in mortality prediction in all groups of patients.
Collapse
Affiliation(s)
- Mirsad Kacila
- Centar za bolesti srca, Klinicki centar Univerziteta u Sarajevu, B&H
| | | | | | | |
Collapse
|
38
|
Abstract
Our aim was to evaluate risk stratification model, European System for Cardiac Risk Evaluation (logistic EuroSCORE) for patients treated in clinical hospital. EuroSCORE is useful to separate patients into risk groups so that the mortality and morbidity risk can be compared. From 1st January 2006 to 31st July 2006 the total of 124 adults have been operated and were classified according to the EuroSCORE algorithm. We have compared correlation of the predicted mortality and observed mortality (as death within the 30 days following the operation) and frequency of postoperative complications. All patients were divided into three risk groups. The low risk group had 30 patients with 0 death (0%) and 1 morbidity (3,33%). The medium risk group had 59 patients with 0 death (0%) and 4 morbidity (6,77%). The high risk group had 35 patients with 2 death (5,71%) and 5 morbidity (14,28%). Mortality in our clinic is much less than predicted mortality and we can be satisfied with our results. Incidence of complications after cardiac surgery is between 25 and 40% (STS database). Our results are within that range. We recommend logistic version of EuroSCORE as good and simple method to predict postoperative prognosis.
Collapse
Affiliation(s)
- Ermina Mujicić
- Heart Center Sarajevo, University of Sarajevo Clinics Center, Bolnicka 25, 71000 Sarajevo, Bosnia and Herzegovina
| | | | | | | | | | | |
Collapse
|
39
|
Kacila M, Schäfer K, Subasić E, Granov N, Omerbasić E, Kucukalić F, Selimović-Mujcić E. Influence of two different types of cardioplegia on hemodilution during and after cardiopulmonary bypass, postoperative chest-drainage bleeding and consumption of donor blood products. Bosn J Basic Med Sci 2007; 6:48-53. [PMID: 16995848 PMCID: PMC7193665 DOI: 10.17305/bjbms.2006.3144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The aim of this study is to compare the effects of colloidal cardioplegia and blood cardioplegia in patients who underwent cardiac surgical procedures with cardiopulmonary bypass, and to evaluate their influence on hemodilution, bleeding and consumption of donor blood products in a retrospective clinical study. 100 male patients who underwent cardiac surgical procedure were divided into two groups: 50 patients were administered intermittent normotherm or mild hypotherm (34 degrees C) Calafiore blood cardioplegia with potassium chloride 14,9%; 50 patients were administered one initial doses of cold Kirsch - solution followed from intermittent cold colloidal cardioplegia using hydroxyethyl starch (HES 450/0,7). Hemoglobin values after the first dose of cardioplegia were significantly lower in the HES-group than in the Calafiore- group). After the first dose of cardioplegia platelets count was lower in the HES-group than in the Calafiore-group. Hemoglobin and hematocrit values 24h postoperative were lower in the HES-group than in the Calafiore-group. There was no difference in chest-drainage bleeding 12h and 24h postoperative between the groups. The consumption of donor erythrocyte concentrate and fresh frozen plasma was significantly higher in the HES-than in the Calafiore- group. The choice of either colloidal or blood cardioplegia does not influence the postoperative chest-drainage bleeding. The results suggest that high molecular colloidal cardioplegia with HES-solution is associated with higher hemodilution during and after cardiopulmonary bypass and significantly increases the consumption of donor blood products.
Collapse
Affiliation(s)
- Mirsad Kacila
- Heart Center Sarajevo, University of Sarajevo Clinics Center, Bosnia and Herzegovina
| | | | | | | | | | | | | |
Collapse
|
40
|
Kacila M, Granov N. [Cardiovascular treatment of patients with Marfan's syndrome]. Med Arh 2007; 61:125-7. [PMID: 17629152] [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: 05/16/2023]
Abstract
Patients with Sy. Marfan, in their great number, find the problem with pathological findings on the heart, but the most dealing complications of this illness are rupture and dissection of aneurismatic aorta. Carefully approach, adequate intervention and what kind of treatment decision, may upgrade quality of the lifestyle and prolong lifespan in this patients. However, the most common death cause in those patients is still rupture of aorta. Treatment of the patients with this problem should go in direction that solves dissection, aortic insufficiency and malperfusion Sy. The most dissection cases are solved by implantation of the valve conduit and reimplantation of the coronary orifices. Some surgeons prefer preservation of the aortic valve, therefore others establish complication prevention pattern with applying surgical treatment before appearance of the complications. In this study we would like to present experience of the Sarajevo Heart Center and our results in the 6 Marfan Sy. cases, within the last two years. We were in position to witnes strong hereditary connection among father and his two daughters who have the same illness. Complications caused by Marfan were successfully removed by surgical treatment. Surgical treatment consists of replacing ascending aorta and in same time replacing coronary ostia using Shelhigh-stentless valve conduit. The same surgical procedure we have performed on two sisters resulted with repair of dissection in first sister's case, and acted complication preventive to the other sister. All this facts indicate necessity for the closeness of the center that is, with experience of employees and their medical and surgical capability, versatile to treat and improve lifestyle to people with Marfan.
Collapse
Affiliation(s)
- Mirsad Kacila
- Centar za srce, Klinicki centar Univerziteta Sarajevo
| | | |
Collapse
|
41
|
Kacila M, Matteucci MLS, Bevilacqua S, Granov N, Glauber M. Treatment of left anterior descending artery aneurysm. Bosn J Basic Med Sci 2006; 6:22-4. [PMID: 17177643 PMCID: PMC5807962 DOI: 10.17305/bjbms.2006.3113] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Coronary artery aneurysms (CAAs) are rare and their management is controversial. Their incidence varies from 1,5% to 5% of the coronary angiographies, with predilection of the right coronary artery. Unruptured coronary aneurysms are often silent and may remain undiagnosed. The etiology can be either congenital or acquired. We describe a case of a left anterior descending artery (LAD) aneurysm treated with an off-pump surgical revascularization with a LIMA to LAD without exclusion or ligature of the aneurysm.
Collapse
Affiliation(s)
- Mirsad Kacila
- Department of Cardiac Surgery--Hospital "G. Pasquinucci" Massa, Via Aurelia sud-Massa, Italy
| | | | | | | | | |
Collapse
|
42
|
Kacila M, Granov N, Mujcić E, Omerbasić E. [IABP and off pump revascularization as prefered method in curement of patients with "low cardiatic output" syndrome]. Med Arh 2006; 60:205-6. [PMID: 16719241] [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: 05/09/2023]
Abstract
Treatment of patients with "low output" syndrome is very complex as well as surgery method as well as post operative treatment. Surgery requests experience and well trained surgical team which is able to produce off pump revascularization of myocardium and in short period of time eliminate global contra effects of ischemia already damaged myocardium. In post surgery period treatment of these patients demands maximal medication support and use of IABP which implantation, in this case, been very useful.
Collapse
Affiliation(s)
- Mirsad Kacila
- Klinika za Kardiohirurgiju, Klinieki Centar Univerziiteta U Sarajevu
| | | | | | | |
Collapse
|
43
|
Kacila M, Granov N, Straus S, Omerbasić E, Saefer K, Donlić E. [Antegrade warm blood cardioplegia compared to crystalloid cardioplegia in myocardial protection]. Med Arh 2006; 60:294-5. [PMID: 16944729] [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: 05/11/2023]
Abstract
The tehniques of myocardial protection in cardiac surgery are innumerable. In this trial we tried to compare two established cardioplegic strategies in elective on-pump surgery (Intermittent antegrade warm blood cardioplegia--Calafiore--) and Kirsch-Solution with Haes). We took the data from our medical documentaton for 115 patients who underwent elective on-pump surgery in time period from February 2005 to July 2005.
Collapse
Affiliation(s)
- Mirsad Kacila
- Klinika za kardiohirurgiju Klinickog centra Univerziteta u Sarajevu
| | | | | | | | | | | |
Collapse
|