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Kamenskaya OV, Klinkova AS, Lomivorotov VV, Shmyrev VA, Chernyavskiy AM. [Predictors of neurological complications after cardiac surgical interventions in oldery patients.]. Adv Gerontol 2020; 33:319-324. [PMID: 32593247] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
To identify predictors of neurological complications in the hospital period after coronary artery bypass grafting (CABG), 92 patients with coronary heart disease aged 70 years and over were analyzed. Intraoperative monitoring of cerebral oxygenation (rSO2, %) was carried out. At the stage of induction anesthesia, the average level of rSO2 for left and right hemispheres was 64-65% without significant changes during the operation. A decrease in rSO2 during cardiopulmonary bypass (CPB) was associated with increased risk of neurological complications. The risk of neurological complications increase 7-fold and 9-fold with a decrease in rSO2 by 20% or more during CPB relative to baseline for left and right hemispheres, respectively. A history of two or more myocardial infarctions increases 3-fold the risk of neurological complications after CABG.
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Affiliation(s)
- O V Kamenskaya
- E.N.Meshalkin National Medical Research Center, 15 Rechkunovskaya str., Novosibirsk 630055, Russian Federation, e-mail:
| | - A S Klinkova
- E.N.Meshalkin National Medical Research Center, 15 Rechkunovskaya str., Novosibirsk 630055, Russian Federation, e-mail:
| | - V V Lomivorotov
- E.N.Meshalkin National Medical Research Center, 15 Rechkunovskaya str., Novosibirsk 630055, Russian Federation, e-mail:
| | - V A Shmyrev
- E.N.Meshalkin National Medical Research Center, 15 Rechkunovskaya str., Novosibirsk 630055, Russian Federation, e-mail:
| | - A M Chernyavskiy
- E.N.Meshalkin National Medical Research Center, 15 Rechkunovskaya str., Novosibirsk 630055, Russian Federation, e-mail:
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Edemskiĭ AG, Cherniavskiĭ AM, Kornilov IA, Shmyrev VA, Moroz GB, Deriagin MN, Novikova NV, Zaĭtseva EA, Galstian MG. [Use of extracorporeal membrane oxygenation for pulmonary haemorrhage after pulmonary endarterectomy]. Angiol Sosud Khir 2019; 25:167-172. [PMID: 31855214 DOI: 10.33529/angio2019415] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Pulmonary haemorrhage is one of the most severe complications of pulmonary endarterectomy. To the most effective methods of combating this potentially fatal complication belongs extracorporeal membrane oxygenation (ECMO). In this article we describe a clinical case report regarding intraoperative use of central veno-arterial ECMO for pulmonary haemorrhage following thromboendarterectomy from the pulmonary arteries. According to the data of some authors, long-term ECMO support (for more than 4 days) may lead to such severe consequences as rethrombosis of pulmonary arteries and impairment of cerebral circulation. In our case we managed to avoid such complications, taking into consideration that the duration of ECMO amounted to 21 days. Resulting from the carried out comprehensive therapeutic measures by the time of discharge from hospital, a significant decrease in pulmonary artery pressure was achieved, with events of residual pulmonary hypertension.
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Affiliation(s)
- A G Edemskiĭ
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A M Cherniavskiĭ
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - I A Kornilov
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - V A Shmyrev
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - G B Moroz
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - M N Deriagin
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - N V Novikova
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - E A Zaĭtseva
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - M G Galstian
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
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Abstract
Aim:to show the analysis of 10-year heart transplantation experience, the main complications and problems of the heart transplantation evaluation. Materials and methods.66 orthotopic heart transplantations were performed in patients with terminal chronic heart failure in our clinic since 2008. The heart failure causes were dilated cardiomyopathy in 46 cases (70%), postinfarction cardiosclerosis in 20 cases (30%). The recipients were 59 men (89%) and 7 women (11%), the average age was 46 ± 10 years. All patients had a severe left heart dilatation and critical left ventricular systolic dysfunction (left ventricular EDV 283 ± 58 ml, left ventricular ejection fraction 17 ± 5%, cardiac index 1.5 ± 0.3 l/min/m2). In some recipients, heart transplantation is performed in the second stage after preliminary implantation of mechanical circulatory support systems (LVAD, BVAD). The fi rst heart transplantations were performed using the biatrial technique (8 cases (12%)), the others were performed using the bicaval technique (58 cases (88%)). After the operation, patients received a three-component immunosuppressive therapy: the inhibitors of calcineurin, mycophenolate and corticosteroids.Results.54 patients (82%) were discharged from the clinic after heart transplantation. The hospital mortality was 12 recipients (18%). The mortality in the long-term period was 10 recipients (15%). The hospital mortality cases were acute graft dysfunction in 5 cases (42%), infectious-septic complications in 4 cases (33%), massive intraoperative bleeding in 2 cases (17%), and total thrombosis of pulmonary artery in 1 case (8%). The death causes in the long-term period were acute transplant rejection in 4 cases (40%), coronary artery disease of the transplanted heart in 3 cases (30%), Kaposi’s sarcoma in 1 case (10%), lung cancer in 1 case (10%), and viral pneumonia in 1 case (10%).Conclusion.Over a 10-year period, we have gained a lot of experience in heart transplantation; the procedures complications have been studied; the stages of preservation, harvesting and transportation of the donor heart, operative technique and postoperative treatment of patients have been improved to avoid complications in the early and long-term postoperative period.
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Affiliation(s)
- A. M. Chernyavskiy
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - D. V. Doronin
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - A. V. Fomichev
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - D. E. Osipov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - V. A. Shmyrev
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
| | - A. M. Karaskov
- Meshalkin National Medical Research Center, Ministry of Health of Russian Federation
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Shmyrev VA, Bogachev-prokofev AV, Lomivorotov VV, Ponomarev DN, Perovskiy PP. Minimally invasive mitral valve surgery. An anesthesiologist''s viewpoint. Patol krovoobrashch kardiokhir 2015. [DOI: 10.21688/1681-3472-2013-4-11-14] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
We conducted a retrospective comparative analysis of 75 patients undergoing video-assisted mitral valve repair with right minithoracotomy over a period from November 2011 to August 2013. The control group comprised 71 patients operated on mitral valve by using median sternotomy during the same period. Median (25th; 75th) times of cardiopulmonary bypass and aortic cross-clamping were significantly longer in the minimally invasive group (180 [139; 224] and 111 [87; 145] min, respectively) as compared to the controls (84 [69; 117] and 62 [49; 81 ] min, respectively), p<0.01. Fatal outcome occurred in 2 (2.7%) cases in the minimally invasive group versus none in the controls. In both cases death resulted from intraoperative aortic dissection. While ventilation time and intensive care unit stay were comparable across the groups, postoperative respiratory failure occurred in 6 (8%) cases in the minimally invasive group versus none in the controls (p<0.05). No other significant differences in the postoperative course were observed between the groups. The results of the present study are generally consistent with the world's tendencies. On the other hand, complication rates observed in the minimally invasive group present a considerable economic burden and require substantial human resources in the postoperative period.
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Lomivorotov VV, Shmyrev VA, Ponomarev DN, Efremov SM, Shilova AN, Postnov VG. [Influence of remote ischemic preconditioning on brain injury markers dynamics during cardiopulmonary bypass]. Anesteziol Reanimatol 2015; 60:33-38. [PMID: 26027222] [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: 06/04/2023]
Abstract
INTRODUCTION Remote ischemic preconditioning has gained clinicians' attention as a technique to protect the heart in patients undergoing cardiac surgery under cardiopulmonary bypass. While experimental data report neuroprotective properties of remote ischemic preconditioning, we failed to find any clinical studies investigating its effects on neurologic outcome in cardiac surgery. PURPOSE OF THE STUDY This prospective randomized placebo-controlled study was undertaken with the aim of elucidating the role of remote ischemic preconditioning for neuroprotection in cardiac surgery. PATIENTS AND METHODS 88 patients with coronary heart disease scheduled for on-pump coronary bypass grafting surgery were randomized to receive either remote ischemic preconditioning or control. We studied S100B peptide and neuron-specific enolase to assess neurological damage. Psychophysiological tests were employed to investigate cognitive function after surgery. RESULTS The perioperative dynamics of S100B and neuron-specific enolase followed similar patterns in both groups throughout the observation period. At the end of surgery, level of S100B was significantly higher in the preconditioning group as compared to controls--0.58 (0.33-0.65) vs. 0.34 (0.23-0.42) mcg/l, p<O. 01). No other significant between-group differences in biochemical markers were observed. No between-group differences in cognitive function and neurologic outcome after surgery were detected. CONCLUSION Our data suggest that remote ischemic preconditioning does not affect neuronal damage and neurologic outcome in patients operated under cardiopulmonary bypass.
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Shmyrev VA, Ponomarev DN, Perovsky PP, BogachevProkofyev AV, Kornilov IA, Lomivorotov VV. The Specific Features of an Early Period after Minimally Invasive Cardiac Surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.15360/1813-9779-2014-4-74-81] [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: 11/18/2022]
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Healy DA, Khan WA, Wong CS, Moloney MC, Grace PA, Coffey JC, Dunne C, Walsh SR, Sadat U, Gaunt ME, Chen S, Tehrani S, Hausenloy DJ, Yellon DM, Kramer RS, Zimmerman RF, Lomivorotov VV, Shmyrev VA, Ponomarev DN, Rahman IA, Mascaro JG, Bonser RS, Jeon Y, Hong DM, Wagner R, Thielmann M, Heusch G, Zacharowski K, Meybohm P, Bein B, Tang TY. Remote preconditioning and major clinical complications following adult cardiovascular surgery: systematic review and meta-analysis. Int J Cardiol 2014; 176:20-31. [PMID: 25022819 DOI: 10.1016/j.ijcard.2014.06.018] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [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: 01/09/2014] [Revised: 05/23/2014] [Accepted: 06/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND A number of 'proof-of-concept' trials suggest that remote ischaemic preconditioning (RIPC) reduces surrogate markers of end-organ injury in patients undergoing major cardiovascular surgery. To date, few studies have involved hard clinical outcomes as primary end-points. METHODS Randomised clinical trials of RIPC in major adult cardiovascular surgery were identified by a systematic review of electronic abstract databases, conference proceedings and article reference lists. Clinical end-points were extracted from trial reports. In addition, trial principal investigators provided unpublished clinical outcome data. RESULTS In total, 23 trials of RIPC in 2200 patients undergoing major adult cardiovascular surgery were identified. RIPC did not have a significant effect on clinical end-points (death, peri-operative myocardial infarction (MI), renal failure, stroke, mesenteric ischaemia, hospital or critical care length of stay). CONCLUSION Pooled data from pilot trials cannot confirm that RIPC has any significant effect on clinically relevant end-points. Heterogeneity in study inclusion and exclusion criteria and in the type of preconditioning stimulus limits the potential for extrapolation at present. An effort must be made to clarify the optimal preconditioning stimulus. Following this, large-scale trials in a range of patient populations are required to ascertain the role of this simple, cost-effective intervention in routine practice.
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Affiliation(s)
| | | | | | | | | | | | | | - C Dunne
- University of Limerick, Ireland
| | - S R Walsh
- National University of Ireland Galway, Ireland
| | - U Sadat
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - M E Gaunt
- Addenbrooke's Hospital, Cambridge, United Kingdom
| | - S Chen
- Central South University, Hunan, China
| | - S Tehrani
- Hatter Cardiovascular Institute, University College London, United Kingdom
| | - D J Hausenloy
- Hatter Cardiovascular Institute, University College London, United Kingdom
| | - D M Yellon
- Hatter Cardiovascular Institute, University College London, United Kingdom
| | | | | | - V V Lomivorotov
- Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - V A Shmyrev
- Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - D N Ponomarev
- Novosibirsk State Research Institute of Circulation Pathology, Novosibirsk, Russia
| | - I A Rahman
- Queen Elizabeth Medical Centre, Birmingham, United Kingdom
| | - J G Mascaro
- Queen Elizabeth Medical Centre, Birmingham, United Kingdom
| | - R S Bonser
- Queen Elizabeth Medical Centre, Birmingham, United Kingdom
| | - Y Jeon
- Seoul National University Hospital, Seoul, South Korea
| | - D M Hong
- Seoul National University Hospital, Seoul, South Korea
| | - R Wagner
- St. Anne's University Hospital, Brno, Czech Republic
| | | | - G Heusch
- University Hospital Essen, Essen, Germany
| | | | - P Meybohm
- University Hospital Frankfurt, Germany; University Hospital Schleswig-Holstein, Kiel, Germany
| | - B Bein
- University Hospital Schleswig-Holstein, Kiel, Germany
| | - T Y Tang
- Changi General Hospital, Singapore
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Lomivorotov VV, Efremov SM, Shmyrev VA, Ponomarev DN, Sviatchenko AV, Kniaz'kova LG. [Cardioprotective effects of glutamine in patients with ischemic heart disease operated under conditions of extracorporeal blood circulation]. Anesteziol Reanimatol 2012:14-18. [PMID: 22834281] [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: 06/01/2023]
Abstract
It was conducted a study of glutamine cardioptotective effects during perioperative use in patients with ischemic heart disease, operated under CB. Exclusion criteria were: left ventricular ejection fraction less than 50%, diabetes melitus, myocardial infarction less than 3 months ago, Patients of the study group (n=25) had glutamine (20% solution N(2)-L-alanine-L-glutamine ("Dipeptiven" Fresenius Kabi, Germany); 0.4 g/kg/day. Patients of control group (n=25) received placebo (0.9% NaCl solution). The main indicators were the dynamics of troponin I, as well as central hemodynamics parameters. On the 1-st day after operation the concentration of troponin I was significantly lower in the glutamine-group compared placebo-group (1.280 (0.840-2.230) 2.410 (1.060-6.600) ng/ml; p=0.035). 4 hours after CB in a glutamine-group also had significantly large indicators of cardiac index (2.58 (2.34-2.91) l/min/m2 vs 2.03 (1.76-2.32)) l/min/m2; p=0,002) and stroke index (32.8 (27.8-36.0.) ml/m2 vs 26.1 (22.6-31.8) ml/m2; p=0.023). Systemic vascular resistance index was significantly lower in glutamine-group (1942 (1828-2209) dyn x s/cm(-5)/m2 vs 2456 (2400-3265) dyn x s/cm(-5)/m2; p=0.001). Conclusion. Perioperative use of N(2)-L-alanine-L-glutamine during the first 24 hours ofperioperative period gives cardioprotective effect in patients with ischemic heart disease operated under CB.
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Lomivorotov VV, Shmyrev VA, Efremov SM. [Efficiency of using gelofusine and voluven in acute normovolemic hemodilution during cardiosurgical interventions]. Anesteziol Reanimatol 2008:10-13. [PMID: 18652167] [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: 05/26/2023]
Abstract
The aim of the study was to assess the use of gelofusine and voluven for acute normovolemic hemodilution at cardiac surgery under extracorporeal circulation (EC). Sixty-seven patients with coronary heart disease were examined. Heart rate, total peripheral vascular resistance, pulmonary pressure, pulmonary artery wedge pressure, oxygen delivery and consumption, central venous pressure, arteriovenous oxygen difference, oncotic pressure, and postoperative clinical course were studied. No significant group differences were found in indices, other than arteriovenous oxygen difference, after acute normovolemic hemodilution and in central venous pressure following 6 hours of EC termination. The administration of gelofusine caused a more steady-state oxygen-transport function of the circulatory system. The use of the agent for acute normovolemic hemodilution at cardiac surgery under EC is more economically justified than that of volumen.
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