1
|
Khalil MA, El Tahan MR, Khidr AM, Fallatah S, Abohamar AD, Amer MM, Makhdom F, El Ghoneimy Y, Al Bassam B, Alghamdi T, Abdulfattah D. Effects of norepinephrine infusion during cardiopulmonary bypass on perioperative changes in lactic acid level (Norcal). Perfusion 2023; 38:1584-1599. [PMID: 35994013 DOI: 10.1177/02676591221122350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hyperlactatemia, a problem reported in up to 30% of cardiac surgery patients, results from excessive production of or decreased clearance of lactate. It is typically a symptom of tissue hypoperfusion and may be associated with the prevalence of postoperative acute mesenteric ischemia and renal failure, or prolonged intensive care unit (ICU) and hospital stay, and increased 30-day mortality. METHODS AND MEASUREMENTS Eighty cardiac surgery patients using cardiopulmonary bypass (CPB) were randomly assigned into either a placebo (n = 39) or norepinephrine 0.05-0.2 µg/kg/min (n = 41) as well as norepinephrine boluses during CPB to maintain mean arterial blood pressure (MAP) at 65 to 80 mm Hg. Patient assignments were done after receiving ethical approval to proceed. The primary result was the perioperative changes in lactic acid level. Secondary findings were also recorded, including hemodynamic variables, the incidence of vasoplegia, intraoperative hypotension, myocardial ischemia, the need for vasopressor support, postoperative complications, and mortality. RESULTS The peak levels and perioperative changes in blood lactate during the first 24 postoperative hours, the number of patients who experienced early hyperlactatemia on admission to the ICU (Placebo: 46.2%, Norepinephrine: 51.2%, p = .650), vasoplegia, hemodynamic changes, incidences of intraoperative hypotension, myocardial ischemia, postoperative complications, and mortality rates were similar in the two groups. Patients in the norepinephrine group received lower intraoperative rescue norepinephrine boluses to maintain the target MAP (p = .039) and had higher MAP values during the CPB and intraoperative blood loss [mean difference [95% confidence interval]; 177 [20.9-334.3] ml, p = .027]. CONCLUSION norepinephrine and placebo infusions during the CPB with the maintenance of MAP from 65 to 80 mmHg had comparative effects on the changes in blood lactate and incidence of vasoplegia after cardiac surgery. Norepinephrine infusion maintained higher MAP values during the CPB.
Collapse
Affiliation(s)
- Mohamed A Khalil
- Consultant, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
- Professor, Anesthesiology Department, College of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed R El Tahan
- Professor, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Alaa M Khidr
- Assistant Professor, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Summayah Fallatah
- Assistant Professor, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Ahmad D Abohamar
- Senior registrar, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
- Lecturer, Anesthesiology Department, College of Medicine, Tanta University, Tanta, Egypt
| | - Mahmoud M Amer
- Senior registrar, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Fahd Makhdom
- Assistant Professor, Department of Surgery Cardiac Surgical Unit, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Yasser El Ghoneimy
- Professor, Department of Surgery Cardiac Surgical Unit, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Bassam Al Bassam
- Demonstrator, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Talal Alghamdi
- Demonstrator, Anesthesiology Department, College of Medicine, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| | - Dalia Abdulfattah
- Clinical Nursing Supervisor Operating Room, Day Surgery, CSSD, Hemodialysis, and PDU, King Fahd Hospital of the Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia
| |
Collapse
|
2
|
Shahid I, Nizam MA, Motiani V, Menezes RG, Naeem U, Siddiqi TJ, Rizwan T, Makhdom F, Ram P, Usman MS. Efficacy and Safety of Oral P2Y12 Inhibitors in Older Patients with Acute Coronary Syndrome: A Frequentist Network Meta-Analysis. Drugs Aging 2021; 38:1003-1016. [PMID: 34664214 DOI: 10.1007/s40266-021-00896-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Previous studies and meta-analyses have assessed optimal P2Y12 inhibitors following acute coronary syndrome in overall trial cohorts. However, there are insufficient data for the elderly cohort who are prone to high bleeding and ischemic events. We aimed to assess the optimal P2Y12 inhibitor therapy for older patients. METHODS PubMed, CENTRAL, and ClinicalTrials.gov databases were searched from inception through July 2020 to identify randomized controlled trials and propensity-matched observational studies including older patients (aged ≥ 65 years) that reported study-defined major adverse cardiovascular events (MACE) or major bleeding events. Outcomes at the mid-term follow-up were pooled to conduct a frequentist network meta-analysis. RESULTS Fourteen studies involving 12,953 older patients were included in our analysis. No significant difference was observed with MACE when all three P2Y12 inhibitors were compared with each other. Compared with clopidogrel, ticagrelor significantly increased the risk of major bleeding (risk ratio 1.35, 95% confidence interval 1.10-1.67) while prasugrel did not (risk ratio 1.02, 95% confidence interval 0.67-1.57). A sensitivity analysis of only randomized controlled trials yielded similar results for both MACE and major bleeding. The P score displayed prasugrel (0.5871) as the best treatment for MACE, while clopidogrel (0.7701) was the best P2Y12 inhibitor to decrease the risk of major bleeding. Ticagrelor (0.0634) was ranked the lowest because of an increased bleeding risk. CONCLUSIONS No significant difference is observed between the three P2Y12 inhibitors in study-defined MACE. Ranking by p-score suggests prasugrel as the best P2Y12 inhibitor to reduce the risk of MACE while clopidogrel is a better alternative than ticagrelor in older patients with acute coronary syndrome to decrease the risk of major bleeding. Because of a lack of individual-patient data analysis and heterogeneity amongst studies, future studies representing older patients with acute coronary syndrome are required to strengthen evidence regarding optimal antithrombotic therapy in this cohort.
Collapse
Affiliation(s)
- Izza Shahid
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | | | - Vanita Motiani
- Department of Medicine, Ziauddin Medical University, Karachi, Pakistan
| | - Ritesh G Menezes
- Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Unaiza Naeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Tariq Jamal Siddiqi
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Tehlil Rizwan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Fahd Makhdom
- Department of Surgery, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Pradhum Ram
- Division of Cardiology, Emory University School of Medicine, Atlanta, GA, USA.
| | | |
Collapse
|
3
|
Othman SA, AlFrayyan OY, AlGhamdi ZM, Makhdom F, AlJehani Y, Elbawab HY, El-Shawarby M. Thymolipoma Association with Myasthenia Gravis: Case Report. Am J Case Rep 2020; 21:e923989. [PMID: 32745075 PMCID: PMC7423170 DOI: 10.12659/ajcr.923989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Patient: Female, 56-year-old Final Diagnosis: Thymolipoma association with myasthenia gravis Symptoms: Acute congestive heart failure • asymptomatic thymolipoma Medication: — Clinical Procedure: — Specialty: Surgery
Collapse
Affiliation(s)
- Sharifah A Othman
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Region, Saudi Arabia
| | - Othman Y AlFrayyan
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Region, Saudi Arabia
| | - Zeead M AlGhamdi
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Region, Saudi Arabia
| | - Fahd Makhdom
- Cardiac Surgery Division, Department of Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Region, Saudi Arabia
| | - Yasser AlJehani
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Region, Saudi Arabia
| | - Hatem Y Elbawab
- Thoracic Surgery Division, Department of Surgery, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Region, Saudi Arabia
| | - Mohamed El-Shawarby
- Department of Pathology, King Fahad Hospital of The University, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Eastern Region, Saudi Arabia
| |
Collapse
|
4
|
Makhdom F, Hage A, Manian U, Ginty O, Losenno KL, Kiaii B, Chu MWA. Echocardiographic Method to Determine the Length of Neochordae Reconstruction for Mitral Repair. Ann Thorac Surg 2020; 111:519-528. [PMID: 32698022 DOI: 10.1016/j.athoracsur.2020.05.129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/28/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND We evaluated a novel formula using preoperative transesophageal echocardiographic measurements to determine neochordae length for repair of degenerative mitral regurgitation (MR). METHODS The formula is based on measuring the distance from the adjacent papillary head to the intended coaptation zone of the flail/prolapsing leaflet segment and subtracting the redundant leaflet length. Between 2008 and 2017, 264 consecutive patients underwent mitral valve repair (82.2% endoscopic, minimally invasive approach and 17.8% sternotomy) with neochordae loop reconstruction (68.6% posterior, 6.4% anterior, and 25% bileaflet repair). Mean patient age was 63 ± 13.6 years, 73.5% were men, and mean left ventricular ejection fraction was 63.1% ± 6.7%. RESULTS Mitral valve repair was successful in 100% of patients, with no patient requiring conversion to replacement. Neochordae length measurement was accurate in 259 patients (98%), with 4 patients requiring conversion to resection and 1 patient requiring longer anterior leaflet neochordae. Median anterior and posterior neochordae lengths were 27 mm (range, 18-32) and 17 mm (range, 9-27), respectively. Intraoperative transesophageal echocardiography demonstrated no or trace residual MR in 254 patients and mild residual MR in 10 patients. In-hospital mortality occurred in 1 patient, and complications included respiratory failure (2.7%) and renal failure (1.8%). At the median follow-up of 12.6 months (interquartile range, 11.1), 98.9% of patients remained free from ≥2+ MR, whereas freedom from reoperation was 100%. CONCLUSIONS Preoperative transesophageal echocardiographic measurements can accurately and reproducibly predict the required length of neochordae loop reconstruction for degenerative mitral valve repair with good results. Longer-term follow-up is necessary.
Collapse
Affiliation(s)
- Fahd Makhdom
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada; Division of Cardiac Surgery, Department of Surgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Ali Hage
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Usha Manian
- Division of Cardiology, Department of Medicine, Western University, London, Ontario, Canada
| | - Olivia Ginty
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Katie L Losenno
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Bob Kiaii
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada
| | - Michael W A Chu
- Division of Cardiac Surgery, Department of Surgery, Western University, London, Ontario, Canada.
| |
Collapse
|
5
|
Algadheeb MS, Makhdom F, Duncan A, Chu MWA. Hybrid Arch Frozen Elephant Trunk Repair of Complex Arch Aneurysm With Severe Arterial Tortuosity. Innovations (Phila) 2019; 14:357-360. [PMID: 31050321 DOI: 10.1177/1556984519842076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with complex aortic arch aneurysms and severe arterial tortuosity represent a unique challenge because of extreme angulations, mixed aneurysm and stenotic disease, and fragile tissues. Novel hybrid arch frozen elephant trunk techniques can expand surgical repair options to include single-stage, complete aortic reconstruction via sternotomy alone, without the need for simultaneous thoracotomy or clamshell incisions. We describe successful hybrid aortic arch reconstruction with Thoraflex Hybrid graft in a patient with complex arch aneurysm and severe arterial tortuosity.
Collapse
Affiliation(s)
- Muhanad S Algadheeb
- 1 Division of Cardiac Surgery, University of Western Ontario, London, Canada
| | - Fahd Makhdom
- 1 Division of Cardiac Surgery, University of Western Ontario, London, Canada
| | - Audra Duncan
- 2 Division of Vascular Surgery, University of Western Ontario, London, Canada
| | - Michael W A Chu
- 1 Division of Cardiac Surgery, University of Western Ontario, London, Canada
| |
Collapse
|
6
|
Abstract
Bochdalek hernias usually present in neonates with respiratory failure, need to be operated early and are associated with a high mortality. We describe an adult patient who came to the emergency department with nonspecific recurrent chest and abdominal pain. A computed tomography scan showed a large posterolateral diaphragmatic defect and an oversized spleen. The hernia was repaired by a thoracoabdominal approach and Gore-Tex patch. Congenital diaphragmatic hernias are rare and are associated with nonspecific symptoms in adults. With suspicious chest or abdominal radiographs, a computed tomography scan is essential to plan an individualized surgical intervention.
Collapse
Affiliation(s)
- Anique Herling
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - Fahd Makhdom
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - Abdullah Al-Shehri
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada
| | - David S Mulder
- Division of Thoracic Surgery, McGill University Health Center, Montreal General Hospital, Montreal, Quebec, Canada.
| |
Collapse
|
7
|
Aljehani Y, Makhdom F, Albuainain H, El-Ghoniemy Y. Primary spontaneous haemopneumothorax: an overlooked emergency. Indian J Chest Dis Allied Sci 2014; 56:113-115. [PMID: 25230553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Primary spontaneous haemopneumothorax (PSHP) is a rare condition. Potentially grave consequences do occur as a result of a failure to reach the diagnosis early. We report a case of a 17-year-old male who presented with a picture of PSHP but was later also found to have a component of haemothorax. He underwent thoracoscopy which was converted to thoracotomy. A torn vascular adhesion was the source of bleeding which was clipped and haemostasis was achieved.
Collapse
|