The present study is the premier clinical attempt to scrutinize the practicability of prophylactic fibrinogen infusion in patients undergoing heart transplantation (HT). A total of 67 consecutive patients who had undergone HT between January 2012 and December 2014 were assessed. After exclusion of some patients, 23 patients were given preoperative 2 g fibrinogen concentrate over a period of 15 minutes after the termination of cardiopulmonary bypass pump and complete reversal of heparin, and 30 patients were not given. Some laboratories were measured before general anesthesia and at 6 and 24 hours after surgery. In addition, major adverse events were also evaluated during hospitalization. The mean age of the patients was 39.5 ± 11.4 years, with a predominance of male sex (77.4%). All laboratories at baseline were comparable between groups. The length of hospital stay was longer in the control group compared to the fibrinogen group (20 [16-22] vs 16 [12-19] days; P = .005). There was a trend for patients in the fibrinogen group to have more acute kidney injury (AKI) after surgery (10% vs 30.4%) and less reoperation for bleeding (20% vs 8.7%). The amount of postoperative bleeding was significantly higher in the control group compared to the fibrinogen group ( P < .001). The number of packed red blood cell transfused during 24 hours after surgery was significantly lower in the fibrinogen group ( P < .001). The transfusion of fibrinogen in patients undergoing HT may be associated with reductions in postoperative bleeding, the number of packed red blood cells, and hospital length of stay; however, it may enhance postoperative AKI.

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.

Introduction Venovenous extracorporeal membrane oxygenation (VV‐ECMO) is a therapeutic strategy for the coronavirus disease 2019 (COVID‐19) induced acute respiratory distress syndrome (ARDS). There are inconclusive data in this regard and causes of VV‐ECMO failure are not yet understood well. Case Series Here, seven patients with COVID‐19‐induced ARDS who underwent VV‐ECMO introduced and causes of VV‐ECMO failure discussed. Medical records of seven COVID‐19 patients treated with VV‐ECMO were retrospectively evaluated to determine the clinical outcomes of VV‐ECMO. Oxygenator failure occurred in four patients whom needed to oxygenator replacement. Successful VV‐ECMO decannulation was done in three patients, however finally one patient survived. Conclusions Hypercoagulability state and oxygenator failure were the most main etiologies for VV‐ECMO failure in our study. All patients with COVID‐19 undergoing VV‐ECMO should be monitored for such problems and highly specialized healthcare team should monitor the patients during VV‐ECMO.

Background:Heart transplant surgeries using cardiopulmonary bypass (CPB) typically requires mechanical ventilation in intensive care units (ICU) in post-operation period. Ultra fast-track extubation (UFE) have been described in patients undergoing various cardiac surgeries.Aim:To determine the possibility of ultra-fast-track extubation instead of late extubation in post heart transplant patients.Materials and Methods:Patients randomly assigned into two groups; Ultra fast-track extubation (UFE) group was defined by extubation inside operating room right after surgery. Late extubation group was defined by patients who were not extubated in operating room and transferred to post operation cardiac care unit (CCU) to extubate.Results:The mean cardiopulmonary bypass time was 136.8 ± 25.7 minutes in ultra-fast extubation and 145.3 ± 29.8 minutes in late extubation patients (P > 0.05). Mechanical ventilation duration (days) was 0 days in ultra-fast and 2.31 ± 1.8 days in late extubation. Length of ICU stay was significantly higher in late extubation group (4.2 ± 1.2 days) than the UFE group (1.72 ± 1.5 days) (P = 0.02). In survival analysis there was no significant difference between ultra-fast and late extubation groups (Log-rank test, P = 0.9).Conclusions:Patients undergoing cardiac transplant could be managed with “ultra-fast-track extubation”, without increased morbidity and mortality.

Intracardiac involvement is a rare presentation of relapsed multiple myeloma. We present a case of lobulated mass in the wall of the right atrium, with extension to the inferior vena cava and obliteration and encasement of the interatrial septum in a 57-year-old man, a known case of multiple myeloma, with progressive exertional dyspnea and anasarca.

Background: Atrial Fibrillation (AF) is a common complication following Coronary artery bypass graft (CABG) Surgery, which may be due to oxidative stress, necrosis and inflammation during CABG and can lead to increases the length of hospital stay and the risk of morbidity and mortality. Melatonin is a hormone with anti-oxidant and anti-inflammatory properties in the cardiovascular system. This study assessed the efficacy of sublingual consumption of melatonin in reducing necrosis and inflammation, in patients undergoing CABG with respect to C-reactive protein (hs-CRP), Creatine KinaseMuscle-Brain subunits (CK-MB) and cardiac Troponin T (cTnT) levels. Methods: One hundred and two patients were enrolled and twenty-six patients were excluded during the study process and finally seventy-six patients undergoing CABG surgery randomly assigned to melatonin group (n = 38, 12 mg sublingual melatonin the evening before and 1 hour before surgery, or the control group which did not receive Melatonin, n = 38). Three patients in the melatonin group and three patients in the control group were excluded from the study because of discontinued intervention and lost to follow up. The samples were collected before and 24 hours after surgery. hs-CRP, CKMB, and cTnT levels were measured in all patients with the Elisa method. Results: There was no significant difference in influencing variables among the groups at the baseline. The incidence of AF following CABG surgery was not statistically significant between the two groups, (p value = 0.71). However, the duration of AF (p value = 0.01), the levels of hs-CRP (p value = 0.001) and CK-MB (p value = 0.004) measured, 24 hours after surgery were significantly lower in the melatonin group. cTnT levels measured 24 hours post-CABG did not show any significant difference in both groups (p value = 0.52). Conclusion: Our findings suggest that the administration of melatonin may help modulate oxidative stress, based on the reduction of the levels of hs-CRP, CK-MB, and the duration of AF following CABG surgery.

The coronavirus disease 2019 (COVID‐19) pandemic has presented unique challenges to healthcare systems the world over. The management of the current pandemic places a huge strain on healthcare sectors and demands new strategies on a global level. We herein review the latest epidemiologic data on the COVID‐19 pandemic, the Iranian healthcare system's response, and the impact on cardiac surgery practice in Iran.

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