63 research outputs found
Re-Entry to the Mediastinum when the Ascending Aorta is Adherent to the Sternum: A Two Stage Sternotomy Approach
No full textRe-entry to the mediastinum, when the ascending aorta aneurysm is adherent to the sternum is characterized by high risk of aneurysm rupture during sternum opening. In such cases, often cardiopulmonary bypass via peripheral vessels is institute and re-entry will be done in deep hypothermia and circulatory arrest. However, long CPB time and adhesion dissection when performed while the patient is heparinized, is demanding and notably time consuming. Also, post operative recovery might be complicated, including, prolonged intubation, kidney dysfunctionand numerous blood transfusions. In order to reduce both risks of aneurysm rupture during resternotomy and those related to prolonged CPB time, we present a surgical approach consisting of a two-stage sternotomy to avoid the risky zone, and extra-anatomic epiaortic vessels anastomoses. This technique presents several advantages: adhesion dissection and access to the heart before the heparin is administrated, simplifying surgical field preparation shorter CPB time, and circulatory arrest
A Novel Endosurgical Prosthesis to Treat Thoracoabdominal Aortic Aneurysm in Complex Anatomy or Emergency Settings
No full textBACKGROUND: Despite improvements in operative techniques, open thoracoabdominal aortic aneurysm (TAAA) repair is complex and characterized by high mortality and morbidity rate. Less invasive techniques have been developed since 2005 for the treatment of TAAA. Unfortunately, many of these devices require custom fabrication, resulting in delay of many weeks until treatment can be delivered but crucial in critical emergency cases. We present a novel hybrid endovascular and surgical prosthesis, which was tested on five pigs, with the aim of reducing the barrier issues of endovascular therapy in such particular cases.METHODS: The principal characteristic of the proposed hybrid endovascular prosthesis is to combine a proximal and distal stented zones and, in between, a classical surgical blood tied Dacron prosthesis. The device was tested in five pigs where feasibility of implantation and acute postoperative outcomes were evaluated, including bleeding, bowel ischemia, renal function, and peripheral blood perfusion.RESULTS: In all cases, following laparotomy, the endoprosthesis was successfully implanted under fluoroscopy and the surgical prosthesis zone could be easily detected by the radio-opaque markers. No major bleeding or cardiac events occurred throughout preparation and implantation. One hour after prosthesis implantation and surgical anastomoses of all vessels were completed, normal urine output was registered, and no acidosis was detected.CONCLUSIONS: This novel graft has shown ease of endoprosthesis and visceral vessels implantation without the need of thoracotomy or extracorporeal circulation and may be useful in an emergency setting or high risk and complex anatomy TAAA unsuitable for traditional endovascular aneurysm repair, or to avoid an excess waiting time for a "custom made" prosthesis. The great adaptability of this "hybrid" prosthesis in complex anatomy for the majority of TAAA could be important in high-risk patients and in some difficult situations, such as a high risk of imminent rupture
LVAD driveline infection: Pump cable relocation in two stage surgical strategy and preventive partial driveline replacement
No full textMechanical left ventricular assist device implantation (LVAD) has become a well-established option for the treatment of patients with severe congestive heart failure. Infection of the driveline is considered the Achilles’ heel of this procedure and the reported surgical approach, by mean of topic and or driveline relocation, is characterized by a high recurrence rate. An alternative approach consisting in a two-stage surgical procedure with the use of antiseptic bath to eradicate the bacteria from the driveline is proposed. Also, a preventive early driveline replacement is suggested with an original technical solution here described
Anesthesia in Patient with Left Ventricular Assist Device LVAD support. A Case Report
No full textBackground; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms
Perioperative Management for Surgical Repair of Ebstein's Anomaly.
No full textBackground: Ebstein's anomaly is a rare and complex heart defect that affects the tricuspid valve and is accountable for around 1% of congenital cardiac abnormalities. It is one of the most common congenital causes of tricuspid valve regurgitation. Ebstein's anomaly often is diagnosed prenatally, due to its severe cardiomegaly. Some individuals with this anomaly do not experience complications until adulthood and even then, they have mostly minor complaints like exercise intolerance. An atrial septal defect is most commonly (70-90%) associated with Ebstein's anomaly. However, ventricular septal defect (VSD) can be associated with 2-6% of the cases.
Case presentation: This report presents a case of surgical intervention for a 38-year-old female with Ebstein's anomaly symptomatic with moderate-severe pulmonary regurgitation and foramen ovale apertum.
Conclusions: Ebstein anomaly is a complicated form of congenital heart disease with variable clinical presentations. The anesthetic plan must also focus on maintenance of RV function and avoidance of increase in PVR. Reversible causes of increased PVR, such as acidemia, hypoxemia, and hypercarbia must be avoided. Agents that lower PVR, such as nitrates, and nitric oxide may be beneficial in patients with severe pulmonary hypertension.
With a sound knowledge of the cardiac anatomy, accurate scheming of surgical outcomes, routine follow-ups, multidisciplinary team approach, and better management, an experienced center can ultimately improve the prognosis of such patients
Unconjugated Hyperbilirubinemia after Open Heart Surgery
No full textThe occurrence of hyperbilirubinaemia after heart surgery using cardiopulmonary bypass or post-operative heart failure is fairly common. Mechanism of hyperbilirubinemiais still not completely clarified, and there are so few specific therapies available for acute hepatobiliary injury. Post-operative mortality well correlates with increasing total bilirubin values, particularly for bilirubin-associate acute kidney tubular necrosis. The difficulty to reduce mortality is partially a consequence of not completely understood physiopathology. It is obvious that long-lasting CPB plays an important role, in association with hemodilution, hypotension, ischemia-reperfusion, and increasing hematic level of endogenous catecholamine with reduction of hepatic blood flow. Case report. A 68 years old man with severe mitral valve regurgitation and pulmonary hypertension and low EF 30%. Mitral valve replacement and tricuspid anuloplastic was performed. Due to low cardiac output syndrome severe hyperbilirubiemeia was seen (24 mg/dl. and unconjugated fraction 16mg/dl) days after. Phenobarbital (luminal) was started 15 mg/kg daily. Two days later the level decreased until 8 mg/dl with normalization of conjugation/unconjugation ratio.Postoperative hyperbilirubinemia is a multifactorial process caused by both impaired liver function of bilirubin transport. In case of elevated level of unconjugated fraction we suggest to use Luminal as alternative for decreasing unconjugated fraction
Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery
No full textBackground: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternative is remifentanil. We compared the efficacity of remifentanil vs morphine -metamizole for post cardiac surgery pain relief.
Methods; Twenty patients undergoing on-pump coronary artery bypass surgery, receiving standardized propofol–fentanyl and propofol based anesthesia, remifentanil group (Group R, n = 10) and fentanyl (Group F, n = 10). Postoperative analgesia was provided in R group initially with remifentanil and later with morphine-metamizole and in F group immediately after operation. Pain was controlled by visual observation, questioning, in rest and during coughing, with a score (0-3).
Results; There is no difference in time of extubation between groups but, pain score was much higher in F (3-9) group in first hour compared with R group (0-4). Morphine requirements was higher in (R) after remifentanil was stopped, in a first hour, but was lower after 24 hours compared with F group. Conclusion: Use of remifentanil is associated with lower scale of pain in postoperative period and lower morphine requirement after 24 hours, when analgesia treatment was changed
Esistere, ossia viaggiare. La visione metaforica della vita in Non c’è dolcezza di Anilda Ibrahimi
No full textLive and travel. The metaphorical vision of life in the novel Non c’è dolcezza by Anilda Ibrahimi The essay, divided into two parts, aims to investigate the motif of journey in the novel Non c’è dolcezza by Anilda Ibrahimi, a migrant author of Albanian origin. The journey is considered mainly as a metaphor for the existence of the characters, who often seem to be puppets completely controlled by fate. These characters “travel” both together (Lila, Eleni) and individually (Arlind, Andrea) in order to determine their identity, realize the dreams which would let them feel happy and forget the problems faced in their everyday lives. Analysis shows that happiness is often impossible because human life is full of negative factors which provoke an existential failure; the message transmitted by Ibrahimi is very pessimistic. The theoretical basis of the article is constituted by the works of such scholars as Theodor Adorno, Giorgio Agamben, Henri Bergson, Roland Barthes, Sigmund Freud, Leszek Kołakowski, Julia Kristeva and Paul Ricoeur
Recensione a Anilda Ibrahimi, "Non c’è dolcezza", Torino, Einaudi, 2012.
No full textI review the novel Non c’è dolcezza (Einaudi 2012) by Anilda Ibrahimi, an Albanian writer who lives in Italy and writes in Italian. In her previous novels - Rosso come una sposa (Einaudi 2008) and L'amore e gli stracci del tempo (Einaudi 2009) – the author focuses her attention on the Balkans civil war and Albanian history.One of the main topics of her writing is the female condition in her country of origin: in her novels she portrays unconventional strong women, that, in spite of the basically patriarchal culture in which they are embedded, always represent the pillars of their families.Ibrahimi’s strong-willed female characters dismantle the stereotypical vision of submissive women that too often Italian readers have.Attention to gender issues, man-woman relationships and social and cultural conditioning are central in the writer’s fictional world
The Benefits of early Extubation in OR and ICU after Cardiac Surgery
No full textObjective: operating room (or) extubation after adult cardiac surgery with cardiopulmonary bypass cPB is rare. We examined the outcome, factors and benefits of OR extubation.Methods: We operated 60 patients in german Hospital tirana, from January 2019 to September 2020, who had undergone caBg cardiac operations: 52 patients, mitral valve repair 5 patients, aortic stenosis 1patient, Bentall procedure 1 patient, left atrial myxoma 1 patient. the patients age was from 46-82 years old, there were 24 female patients and 36 male patients, 24 diabetic patients, 36 non-diabetic patients, in all cases we did not apply epidural anesthesia. Anesthesia was used with low doses of fentanyl. in combination with propofol, sevoflurane. In all cases neostigmine was used for decurarisation.the quality and depth of anesthesia was assessed with obvious signs such as tachycardia, hypertension, sweating. endogenous stress was also assessed by monitoring glycemia during the intervention.as extubation criteria were assessed the patient’s consciousness, respiratory mechanics, hemodynamic stability, diuresis, bleeding from drains.Results: 16 patients were extubated in the or and 44 patients were extubated 15-20 minutes after the intervention in icU. there was no reintubation. 2 patients were transferred immediately from or to the repart. 35 patients were transferred to the ward 3-4 hours after extubation. 23 patients were transferred to the ward the next morning. Patients left the hospital after 5-7 days.Conclusions:extubation in the or in the early postoperative period has now become a routine in all specialized clinics. the time spent in the ICU is very low and the day spent in the ward was 5-7 days. The benefit is in the best and fastest activation of patients in the early postoperative period as well as in reduced intervention costs
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