The effects of recent Covid-19 pandemic on this planet must be viewed with a wise eye and we should learn that human beings are interconnected chains, and that ignoring the laws of existence will undoubtedly continue with reflections similar to the way we are today. Although the community of heart surgeons is not at the forefront of the treatment of this epidemic, they are ready to rush to the aid of other colleagues if necessary. The aim of preparing this protocol is to prioritize cardiac surgery procedures, maintain blood and blood product reserves and provide the appropriate care for patients while taking precautions for the safety of medical staff. The general recommendation in this first version of protocol is to postpone all elective cardiac surgeries and perform emergent and urgent cases according to suggested personal protection strategies for Covid-19.
Heart failure is a leading cause of death around the world. Heart transplantation is the only reliable therapy for improving functional capacity, quality of life, life expectancy, and limiting the options for heart failure patients. In fact, a large number of patients with severe heart failure in need of heart transplantation are unable to receive therapy with up to 30% mortality before a heart is donated. In recent decades, cardiac replacement and assisting therapies have presented promising outcomes to treat these end-stage patients as alternative solutions. These devices are capable of providing temporary to permanent, partial or full assistance. Such devices can be divided into two categories based on location and mechanism of augmentation: 1) devices exposed directly to blood including ventricular assistive devices (VADs) and total artificial hearts (TAHs) and 2) devices that augment cardiac output through compression of ventricles or another part of circulatory system with no direct contact to blood such as extra-cardiac compression devices (ECCDs). In recent years, novel ECCDs which compress tissue and muscles to indirectly assist blood pumping have been developed to circumscribe problems associated with blood-contacting devices and the risks involved with piercing arterial and ventricular walls. Not only do ECCDs aim to reduce risks from the patient and surgeon perspective, the complexity of engineering an intra-corporeal extra-cardiac device is also reduced.
: The Iranian society of cardiac surgeons (ISCS) has been holding a regular meeting every two months since 2005. This is the report of one of the mentioned meetings in which three interesting cardiac surgery cases were presented and discussed.
Phaeochromocytomas/paragangliomas (PPGL) are rare tumours that can cause cardiovascular complications following the secretion of catecholamines. We present a young female presented with heart failure with reduced ejection fraction as a result of norepinephrine secreting para‐aortic paraganglioma and improvement of heart failure sign and symptoms and left ventricular ejection fraction following tumour resection.
Background
Dual antiplatelet therapy (DAPT) in patients with MI who are candidates for early coronary artery bypass grafting (CABG) can affect intraoperative and postoperative outcomes. Therefore, the aim of this study was to evaluate the effect of DAPT up to the day before CABG on the outcomes during and after surgery in patients with MI.
Methods
In this prospective cohort study, 224 CABG candidate patients with and without MI were divided into two groups: (A) patients without MI who were treated with aspirin 80 mg/day before surgery (noMI-aspirin group; n = 124) and (B) patients with MI who were treated with aspirin 80 mg/day before surgery and clopidogrel (Plavix brand) at a dose of 75 mg/day (MI-DAPT group; n = 120). Dual or mono-antiplatelet therapy continued until the day before surgery. Patients were followed to assess in-hospital and 6-months outcomes.
Results
The in-hospital mortality in MI-DAPT group was similar with noMI-aspirin group (OR 4.2; 95% CI 0.9–20.5; p = 0.071). The prevalence of CVA (p = 0.098), duration of hospital stay (p = 0.109), postoperative ejection fraction level (p = 0.693), diastolic dysfunction grade (p = 0.651) and postoperative PAP level (p = 0.0364) did not show difference between two groups. No mild or severe bleeding was observed in the patients. Six-month follow up showed that number of readmissions (p = 0.801), number of cases requiring angiography (p = 0.100), cases requiring re-PCI (p = 0.156), need for re-CABG (p > 0.999) and CVA (p > 0.999) did not differ between the two groups. During the 6-month follow-up, out-hospital mortality did not differ significantly between the two groups (p = 0.446).
Conclusions
A 6-month follow-up showed that DAPT with aspirin and clopidogrel before CABG in patients with MI has no effect on postoperative outcomes more than mono-APT with aspirin. Therefore, DAPT is recommended in the preoperative period for these patients.
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