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Ananiadou O, Fazekas L, Vlahou A, Ampatzidou F, Madesis A, Karaiskos T, Drossos G. Integrating continuous monitoring and evaluation of risk-adjusted outcomes in a cardiac surgical program. J Card Surg 2019; 35:151-157. [PMID: 31710753 DOI: 10.1111/jocs.14345] [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: 11/30/2022]
Abstract
BACKGROUND The variable life-adjusted display (VLAD) method shows the difference between predicted and observed outcomes over time. Our study aims to implement routine in-house monitoring of risk-adjusted 30-day mortality and morbidity following cardiac surgery. METHODS The Society of Thoracic Surgeons (STS) risk score was calculated for 249 isolated and combined coronary and aortic or mitral valve cases performed during a 6-month period. The nine predicted STS variables were operative mortality, permanent stroke, renal failure (RF), prolonged ventilation, deep sternal wound (DSW) infection, reoperation for any reason, short and long length of stay (LOS), and major morbidity or operative mortality. EuroSCORE II was also calculated for the study population. VLAD plots were generated for each variable indicating whether performance is better or worse than expected on the basis of predicted risk of failure. RESULTS The mortality plot was fluctuating close to baseline risk. The prolonged ventilation, RF, reoperation, morbidity/mortality, and LOS plots were consistently positive, indicating favorable results. The stroke chart showed an upward trend for most of the period until two incidents toward last month led to a steep descent. The DSW infections plot though, indicated a worse-than-expected performance. The VLAD charts were shared in multidisciplinary meetings and clinicians were able to confront the performance with the population-specific expectancies and respond to adverse trends with further actions. CONCLUSION Graphical tool monitoring of risk-adjusted 30-day mortality and morbidity following cardiac surgery is feasible and allows detection of underperformance and implementation of changes in clinical practice.
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Affiliation(s)
- Olga Ananiadou
- Cardiothoracic Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Levente Fazekas
- Cardiothoracic Surgery Department, Semmelweis University, Budapest, Hungary
| | - Athanasia Vlahou
- Cardiothoracic Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Fotini Ampatzidou
- Cardiothoracic ICU Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Athanasios Madesis
- Cardiothoracic Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - Theodoros Karaiskos
- Cardiothoracic Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
| | - George Drossos
- Cardiothoracic Surgery Department, G. Papanikolaou General Hospital of Thessaloniki, Thessaloniki, Greece
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Ananiadou O, Schmack B, Zych B, Sabashnikov A, Garcia-Saez D, Mohite P, Weymann A, Mansur A, Zeriouh M, Marczin N, De Robertis F, Simon AR, Popov AF. Suicidal hanging donors for lung transplantation: Is this chapter still closed? Midterm experience from a single center in United Kingdom. Medicine (Baltimore) 2018; 97:e0064. [PMID: 29620623 PMCID: PMC5902298 DOI: 10.1097/md.0000000000010064] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In the context of limited donor pool in cardiothoracic transplantation, utilization of organs from high risk donors, such as suicidal hanging donors, while ensuring safety, is under consideration. We sought to evaluate the outcomes of lung transplantations (LTx) that use organs from this group.Between January 2011 and December 2015, 265 LTx were performed at our center. Twenty-two recipients received lungs from donors after suicidal hanging (group 1). The remaining 243 transplantations were used as a control (group 2). Analysis of recipient and donor characteristics as well as outcomes was performed.No statistically significant difference was found in the donor characteristics between analyzed groups, except for higher incidence of cardiac arrest, younger age and smoking history of hanging donors (P < .001, P = .022 and P = .0042, respectively). Recipient preoperative and perioperative characteristics were comparable. Postoperatively in group 1 there was a higher incidence of extracorporeal life support (27.3 vs 9.1%, P = .019). There were no significant differences in chronic lung allograft dysfunction-free survival between group 1 and 2: 92.3 vs 94% at 1 year and 65.9 vs 75.5% at 3 years (P = .99). The estimated cumulative survival rate was also similar between groups: 68.2 vs 83.2% at 1 year and 68.2% versus 72% at 3 years (P = .3758).Hanging as a donor cause of death is not associated with poor mid-term survival or chronic lung allograft dysfunction following transplantation. These results encourage assessment of lungs from hanging donors, and their consideration for transplantation.
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Affiliation(s)
- Olga Ananiadou
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Bastian Schmack
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Bartlomiej Zych
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Diana Garcia-Saez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Prashant Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Alexander Weymann
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Ashham Mansur
- Department of Anesthesiology, University Medical Center, Georg August University, Goettingen, Germany
| | - Mohamed Zeriouh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Nandor Marczin
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, Heart Science Centre, Harefield Hospital, Harefield
- Section of Anaesthetics, Pain Medicine and Intensive Care, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital, London, United Kingdom
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Andre Rüdiger Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, United Kingdom
- Department of Cardiothoracic Surgery, University of Frankfurt, Frankfurt, Germany
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Mohite PN, Zeriouh M, Sáez DG, Popov AF, Sabashnikov A, Zych B, Padukone A, Fazekas L, Ananiadou O, De Robertis F, Soresi S, Reed A, Carby M, Simon AR. Influence of history of cannabis smoking in selected donors on the outcomes of lung transplantation. Eur J Cardiothorac Surg 2017; 51:142-147. [PMID: 28077504 DOI: 10.1093/ejcts/ezw255] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 05/22/2016] [Accepted: 06/06/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Cannabis is the most commonly abused illicit drug and the smokers are at the risk of lung infections, bullous emphysema and lung cancer. However, no evidence about the outcomes of lung transplantation (LTx) utilizing the lungs from such donors is available in the literature. METHODS We retrospectively analysed lung 'organ offers' and LTx at our centre between January 2007 and November 2013. The outcomes of LTx utilizing lungs from donors with a history of cannabis smoking were compared with the outcomes of those with no such history using unadjusted model as well as propensity score matching. RESULTS A total of 302 LTxs were performed during this period and were grouped depending on the history of cannabis smoking in donors-'cannabis' (n = 19) and control group (n = 283). All the donors in 'cannabis' group were tobacco smokers compared with 43% in the control group. Preoperative characteristics in recipients in both groups were comparable. Intraoperative and post-LTx variables including 1- and 3-year survivals were comparable in both groups. CONCLUSIONS The history of donor cannabis smoking does not appear to affect early and mid-term outcomes after LTx and potentially improve the donor pool. As it does not seem to negatively affect the outcomes after LTx, it should not be per se considered a contraindication for lung donation.
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Affiliation(s)
- Prashant N Mohite
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Mohamed Zeriouh
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Diana G Sáez
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Aron-Frederik Popov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Anton Sabashnikov
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Bartlomiej Zych
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Ashok Padukone
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Levente Fazekas
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Olga Ananiadou
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Fabio De Robertis
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Simona Soresi
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Anna Reed
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - Martin Carby
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
| | - André R Simon
- Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Harefield, UK
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Ananiadou O, Zych B, Garcia Saez D, Mohite P, Schmack B, Fazekas L, Husain M, Jothidasan A, Sabashnikov A, Weymann A, Reed A, Carby M, De Robertis F, Simon A, Popov A. Suicidal Hanging Donors for Lung Transplantation: Is This Chapter Still Closed? Midterm Experience from a Single Centre. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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García Sáez D, Zych B, Mohite P, De Robertis F, Bowles C, Sabashnikov A, Ananiadou O, Schmack B, Maunz O, Popov A, Bahrami T, Banner N, Simon A. Midterm Follow up of Heart Transplantation with Routine Ex-Vivo Normothermic Preservation with Adverse Donor - Recipient Risk Profile. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Zych B, Garcia-Saez D, Ananiadou O, Mohite P, Jothidasan A, De Robertis F, Popov A, Bahrami T, Reed A, Carby M, Simon A. Extracorporeal Membrane Oxygenation (ECMO) as a Bridge to Lung Transplantation (Ltx) - Influence of Concomitant Mechanical Ventilation on Outcome. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1186] [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: 11/29/2022] Open
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Schmack B, Weymann A, Mohite P, Garcia Saez D, Zych B, Sabashnikov A, Zeriouh M, Schamroth J, Koch A, Soresi S, Ananiadou O, De Robertis F, Karck M, Simon AR, Popov AF. Contemporary review of the organ care system in lung transplantation: potential advantages of a portable ex-vivo lung perfusion system. Expert Rev Med Devices 2016; 13:1035-1041. [DOI: 10.1080/17434440.2016.1243464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Koutsogiannidis CP, Ampatzidou F, Madesis A, Karaiskos T, Ananiadou O, Diplaris K, Malamas A, Drossos G. Routine innominate artery cannulation for elective ascending aortic surgery. A single-centre experience. J Cardiothorac Surg 2015. [PMCID: PMC4695721 DOI: 10.1186/1749-8090-10-s1-a265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Koutsogiannidis C, Ananiadou O, Ampatzidou F, Mytilinaios D, Troupis T, Charchanti A, Drossos G, Johnson E. 007 * DECREASED DNA DISRUPTION IN THE PORCINE NEOCORTEX WITH ERYTHROMYCIN PRECONDITIONING DURING PROLONGED HYPOTHERMIC CIRCULATORY ARREST: EVIDENCE FOR NEUROPROTECTION. Interact Cardiovasc Thorac Surg 2014. [DOI: 10.1093/icvts/ivu276.7] [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: 11/13/2022] Open
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10
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Drossos G, Koutsogiannidis CP, Ananiadou O, Kapsas G, Ampatzidou F, Madesis A, Bismpa K, Palladas P, Karagounis L. Pericardial fat is strongly associated with atrial fibrillation after coronary artery bypass graft surgery†. Eur J Cardiothorac Surg 2014; 46:1014-20; discussion 1020. [PMID: 24652814 DOI: 10.1093/ejcts/ezu043] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Recent evidence suggests that pericardial fat may represent an important risk factor for cardiovascular disease because of its unique properties and its proximity to cardiac structures. It has been reported that pericardial fat volume (PFV) is associated with atrial fibrillation (AF). The purpose of this study was to investigate the association between PFV and new-onset AF following coronary artery bypass graft surgery (CABG). METHODS PFV was measured using computed tomography in 83 patients with coronary artery disease scheduled to undergo elective isolated on-pump CABG. Patient characteristics, medical history and perioperative variables were prospectively collected. Any documented episode of new-onset postoperative AF until discharge was defined as the study end point. RESULTS Twenty-eight patients (33.7%) developed postoperatively AF during hospital stay. There was no significant difference in demographics and comorbidities among patients that maintained sinus rhythm (SR) and their AF counterparts. In univariate analysis, patients with postoperative AF had significantly more pericardial fat compared with SR patients (195 ± 80 ml vs 126 ± 47 ml, P = 0.0001). Larger left atrial diameter was also associated with postoperative AF (42.4 ± 6.9 mm vs 39.3 ± 4.8 mm, P = 0.017). Additionally, the prebypass use of calcium channel-blocking agents was independently associated with a lower incidence of postoperative AF, confirmed also by multivariate analysis (P = 0.035). In multivariate logistic regression analysis, PFV was the strongest independent variable associated with the development of postoperative AF (odds ratio: 1.018, 95% confidence interval: 1.009-1.027, P = 0.0001). The best discriminant value assessed by receiver operating characteristic analysis was 129.5 ml (sensitivity 86% and specificity 56%). CONCLUSIONS PFV is strongly associated with AF following CABG, independently of many traditional risk factors. Our findings suggest that PFV may represent a novel risk factor for postoperative AF. However, the role of pericardial fat in AF mechanism needs to be further delineated.
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Affiliation(s)
- George Drossos
- Department of Cardiothoracic Surgery, General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | | | - Olga Ananiadou
- Department of Cardiothoracic Surgery, General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - George Kapsas
- Department of Radiology, General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Fotini Ampatzidou
- Department of Cardiothoracic Surgery, General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Athanasios Madesis
- Department of Cardiothoracic Surgery, General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Kalliopi Bismpa
- Department of Radiology, General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Panagiotis Palladas
- Department of Radiology, General Hospital 'G. Papanikolaou', Thessaloniki, Greece
| | - Labros Karagounis
- Department of Interventional Cardiology, Interbalkan Medical Center, Thessaloniki, Greece
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Koutsogiannidis CP, Ananiadou O, Kapsas G, Madesis A, Palladas P, Drossos G. 'Early' post-cardiotomy chylopericardium and the imaging value of magnetic resonance thoracic-ductography. Heart Lung Circ 2013; 22:1033-5. [PMID: 24314895 DOI: 10.1016/j.hlc.2013.04.004] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 03/21/2013] [Accepted: 04/07/2013] [Indexed: 11/25/2022]
Abstract
Isolated chylopericardium is a rare postoperative complication after cardiac surgery. A delay in diagnosis or an inappropriate management can lead to serious consequences. The treatment, which may either be conservative or surgical, is controversial and it depends on the duration and volume of effusion. We report a case of chylopericardium after atrial septal defect repair in a young woman. The patient was treated initially with total parenteral nutrition for 10 days. After drainage diminished, low fat diet containing medium chain triglyceride was instituted. Postoperatively, the role of magnetic resonance thoracic ductography was important for the assessment of the treatment strategy.
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Drossos G, Koutsogiannidis C, Ananiadou O, Kapsas G, Bismpa K, Karagounis L. 330 * PERICARDIAL FAT IS STRONGLY ASSOCIATED WITH ATRIAL FIBRILLATION AFTER CORONARY ARTERY BYPASS GRAFT SURGERY. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.330] [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: 11/13/2022] Open
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Koutsogiannidis C, Ampatzidou F, Ananiadou O, Diplaris K, Troupis T, Charchanti A, Drossos G, Johnson E. Erythromycin induced neuroprotection during prolonged deep hypothermic circulatory arrest in an acute porcine model. J Cardiothorac Surg 2013. [PMCID: PMC3844645 DOI: 10.1186/1749-8090-8-s1-o24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Chalvatzoulis E, Ananiadou O, Madesis A, Christoforidis T, Katsaridis V, Drossos G. Unligated left internal mammary artery side branch resulting in coronary artery steal syndrome. J Card Surg 2012; 26:487-90. [PMID: 21951036 DOI: 10.1111/j.1540-8191.2011.01297.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Whether internal mammary artery side branches have the potential for hemodynamically significant flow steal in cases of postcoronary surgery ischemia remains a controversial issue. We present a case in which coil embolization of two unligated side branches resulted in symptomatic improvement and resolution of ischemia as evidenced by myoview imaging.
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Papoulidis P, Ananiadou O, Chalvatzoulis E, Ampatzidou F, Koutsogiannidis C, Karaiskos T, Madesis A, Drossos G. The role of ascorbic acid in the prevention of atrial fibrillation after elective on-pump myocardial revascularization surgery: a single-center experience--a pilot study. Interact Cardiovasc Thorac Surg 2010; 12:121-4. [PMID: 21098510 DOI: 10.1510/icvts.2010.240473] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Atrial fibrillation (AF) is a common arrhythmia that occurs postoperatively in cardiac surgery. There is evidence for the role of oxidative stress in the etiology of AF. In our study, we examined whether antioxidant ascorbic acid (vitamin C), could help in the reduction of the incidence of postoperative AF. Patients who were scheduled to undergo elective isolated on-pump coronary artery bypass grafting (CABG) were included in our study. One hundred and seventy patients were randomly divided in two groups: Group A (n=85) received vitamin C preoperatively and postoperatively whereas Group B (n=85) did not receive any (control group). The incidence of AF was 44.7% in the vitamin C group and 61.2% in the control group (P=0.041). The hospitalization time, the intensive care unit stay and the time interval for the conversion of AF into sinus rhythm was significantly shorter in the vitamin C group. Patients that developed AF also had longer hospital length of stay (9.5±2.8 days vs. 6.7±1.9, P=0.034). Supplementation of vitamin C reduces the incidence of postCABG AF, and decreases the time needed for rhythm restoration and length of hospital stay.
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Affiliation(s)
- Pavlos Papoulidis
- Department of Cardiothoracic Surgery, General Hospital G. Papanikolaou, Exohi, 57010 Thessaloniki, Greece
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Chalvatzoulis E, Megalopoulos A, Trellopoulos G, Ananiadou O, Papoulidis P, Kemanetzi I, Madesis A, Drossos G. Endovascular repair of traumatic aortic transection. Interact Cardiovasc Thorac Surg 2010; 11:238-42. [DOI: 10.1510/icvts.2010.235473] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Ananiadou O, Karaiskos T, Givissis P, Drossos G. Operative stabilization of skeletal chest injuries secondary to cardiopulmonary resuscitation in a cardiac surgical patient. Interact Cardiovasc Thorac Surg 2009; 10:478-80. [PMID: 20007637 DOI: 10.1510/icvts.2009.218750] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Chest injury, including sternal and rib fractures, is the most common complication of cardiopulmonary resuscitation (CPR) that usually heals spontaneously. However, a small subset of patients has fractures that need mechanical treatment. We present a case of flail chest with sternum and left anterior rib fractures secondary to CPR in a cardiac surgical patient, which was mechanically ventilated due to respiratory complications. Open reduction and operative fixation with titanium osteosynthesis plates and locking screws in sternum and ribs was performed by a thoracic surgeon assisted by an orthopaedic surgeon. Anterior plating achieved chest stability and facilitated weaning from mechanical ventilation. The patient had an uneventful postoperative course, painfree, and experienced no sternal instability or infection throughout a six-month follow-up period. Sternal instability after cardiac surgery occurs infrequently but can be challenging to manage. Titanium plate fixation is an effective method to stabilize complicated flail chest, with clinical utility in a cardiothoracic practice.
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Affiliation(s)
- Olga Ananiadou
- Department of Cardiothoracic and Vascular Surgery, G. Papanikolaou General Hospital, Thessaloniki, Greece.
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Johnson EO, Ananiadou O. Reply to the Editor. J Thorac Cardiovasc Surg 2007. [DOI: 10.1016/j.jtcvs.2007.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Anagnostopoulos CE, Siminelakis S, Ananiadou O, Katsaraki A, Drossos G, Katritsis D, Panagiotopoulos J, Papadopoulos G. "Learning curves" of cardiac surgery in relation to risk stratification and hospital location. J Cardiovasc Surg (Torino) 2003; 44:591-6. [PMID: 14974485] [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: 04/29/2023]
Abstract
AIM The purpose of this study was to determine any significant differences in "learning curves" between private and public hospitals when the same senior surgeon was responsible during the initial phases of open-heart surgery programs development, in relation to risk stratification and hospital location. METHODS A prospective review of 610 patients records was performed at a newly-opened cardiothoracic program in a public University Hospital (PUH) in the periphery of Greece, and a private institution (PI) with an experienced intensive care unit (ICU) in the capital city of Athens. Preoperative risk stratification, mortality and postoperative length of stay (LOS) were analysed between 1999 to 2001. RESULTS At PUH 298 patients were operated and 312 patients at PI. There were 136 low risk (EuroSCORE 0-2) and 474 medium and high-risk patients (EuroSCORE > or =3). There was no significantly elevated mortality or learning curve in low risk surgery either at PUH (57 patients with 1 death) or PI (79 patients and 1 death). In medium and high-risk surgery at PI there was no mortality in 68 patients operated by the senior surgeon and no learning curve in all 233 such patients. In 240 medium and high-risk patients at PUH there was a learning curve despite the involvement of the same senior surgeon. In 1999 and 2000 the observed mortality (OM) in 150 patients was 15.33%, EuroSCORE 5.98, and in 2001 in 91 patients OM 3.29%, EuroSCORE 5.95 with p=0.00.8 when "experienced" ICU staff was employed. LOS was significantly reduced in 97 patients in 2001 at PUH (8.7 d +/- 2.81 vs 11.07 days +/- 7.9 in 1999 and 2000, p=0.046) confirming the existence of a learning curve at the PUH. No such change was observed at PI (8.2 days vs 7.8, p=0.45). CONCLUSION No mortality differences or learning curve characteristics were detected for low risk operations either at PUH or PI. For medium and high risk surgery there appears to be a learning curve in PUH but not in PI despite senior surgeon involvement in both. The presence of an experienced ICU appears to play a critical role in the outcome of operations in newly opened cardiothoracic programs.
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