16 research outputs found
Analysis of the Detection Rate and Results of Surgical Treatment of Patients with Infective Endocarditis With/Without <i>COVID</i>-19
No full textAIM OF STUDY. To analyze results of surgical treatment of infective endocarditis in the context of the COVID-19 pandemic at the N. V. Sklifosovsky Research Institute for Emergency Medicine. MATERIAL AND METHODS. From January, 2021 to April, 2022 at N.V. Sklifosovsky Research Institute for Emergency Medicine we performed 59 surgical interventions on patients diagnosed with infective endocarditis, of which 20 patients (33.9%) had a competing diagnosis “new coronavirus infection”. RESULTS. The overall mortality was for the specified period was 18.6 %, 11 patients. In the first group, 5 patients died (25 %). Hospital mortality in the second group was 6 patients (15.4 %). CONCLUSION. Preoperative preparation, as well as the surgical intervention itself, did not differ significantly between patients in the two groups. Hospital mortality in the group of patients with new coronavirus infection was higher than in patients without the virus, despite the fact that the risk of surgical intervention according to EuroSCORE II was higher in the second group. From which we can conclude that the EuroSCORE risk scale II does not fully reflect the initial severity of the condition of patients with COVID-19. Such risk factors as decreased immunity due to immunosuppressive therapy and respiratory failure and coagulopathy influenced the results of surgical treatment of infective endocarditis in this cohort of patients, but not so significantly as to refuse surgical intervention. The significant difference in the postoperative period was the increase in bed days in intensive care and therapeutic departments among patients with COVID-19. This factor is associated with the initial severity and specifics of management of these patients in the postoperative period, which required greater vigilance and attention from cardiac surgeons, resuscitators and infectious disease doctors in the “red” zones
Computed Tomography Criteria for Differential Evaluation of True and False Lumens in Aortic Dissection
No full textThe aim of study Based on computed tomography data, to determine the most characteristic criteria for true lumen (TL) and false lumen (FL) in aortic dissection. To identify the relationship of the studied features with the stage of aortic dissection.Materials of the study Computed tomography (CT) data of 115 patients diagnosed with aortic dissection (AD) who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The average age of the patients was 54.5 years (median — 56 years), men predominated in the studied group. AD types according to the De Bakey classification were distributed as follows: Type I — in 47% of patients, Type II — in 16.5%, Type III — in 36.5%. Dissection in the acute stage occurred in 62% of the patient, in the subacute — in 16%, in the chronic — 22%.Results In the studied group, FL in all cases prevailed over the TL by size, regardless of the stage and type of AD. Analysis of lumen ratio showed that in 63.55% of patients, FL occupied 75% or more of the aortic cross-sectional area. Location of FL: at the level of the ascending aorta, along the right and anterior walls of the aorta — 94.5%; in the descending thoracic aorta, along the posterior and left walls — 84%; in the abdominal aorta, along the posterior and left walls — 70%. Calcifications of the non- dissected part of the aortic wall, as a sign of a true lumen, were found in 59.1%. There was no correlation between calcification and the AD stage. Partial thrombosis of one of the lumens was detected in 59% (in FL — 85%, in TL — 13%, thrombosis of both lumens — 2%). The beak signs occurred in 85% of patients with AD, however, it was significantly more often detected in patients with acute and subacute AD stages than in the chronic stage (p<0.001). The cobweb sign was found in one third of patients with AD, however, it was statistically significantly more often determined in patients in acute and subacute stages (p<0.05).Conclusion CT is reasonably considered a highly informative method of diagnosing AD. The signs of true and false lumen presented in the work, as well as their combination, make it possible to perform a quick and error-free marking of the aortic lumen with a high degree of probability. A number of the described CT signs correlate with the stage of AD
Acute Kidney Injury in Patients with Novel Coronavirus Infection <i>COVID</i>-19 After Cardiac Surgery
No full textRELEVANCE. The novel coronavirus (SARS-CoV2) infection (COVID-19) was first identified in China and quickly spread throughout the world, becoming a public health emergency. Acute kidney injury (AKI) occurs in 8–60% of patients with COVID-19 and is associated with significant mortality, especially in patients requiring renal replacement therapy (RRT). Identification of risk factors for the development of AKI, analysis of the course of this life-threatening condition, study of the use of RRT and extracorporeal hemocorrection (ECHC) in patients with COVID-19 after cardiac surgery is of significant interest. AIM OF THE STUDY. To identify risk factors for the development of AKI, assess the incidence of complications and treatment outcomes in patients with COVID-19 after cardiac surgery. To study the experience of using RRT and ECHC methods. MATERIAL AND METHODS. We examined 23 patients with a confirmed diagnosis of COVID-19 who were treated in the Infectious Diseases Department of the N. V. Sklifosovsky Research Institute for Emergency Medicine in 2021. Of these, 19 were men (82.6%), and 4 — women (17.4%). The mean age of the patients was 42 years. All the patients required emergency cardiac surgery. Depending on the development of AKI, which required the use of RRT and ECHC methods, patients were divided into two groups: in 10 patients with the development of AKI and multiple organ dysfunction, the use of RRT and ECHC methods was required (group 1); in 13 patients without AKI, standard therapy was used (group 2). Twenty-two patients underwent surgery using cardiopulmonary bypass (CPB), and 1 — without CPB. Indications for the use of RRT and ECHC methods in the patients were the development of AKI, including against the background of chronic kidney disease, in accordance with the KDIGO-2012 criteria, as well as sepsis, septic shock, acute respiratory distress syndrome, water-electrolyte imbalance, acid-base imbalance, systemic inflammation and “cytokine storm”. CONCLUSIONS. 1. In patients with COVID-19 who require cardiac surgery, the development of acute kidney injury worsens the prognosis of the disease and is accompanied by a statistically significant increase in the duration of mechanical ventilation, the median was 3.2 days compared to 1.0 day in group 2, and the period of stay in the intensive care unit was 16.5 days and 9 days, respectively. 2. Mortality was 30 % in group 1, and 15 % in group 2, p = 0.475; in patients with acute kidney injury, there was a tendency towards a more frequent development of postoperative complications — thus, acute cerebrovascular accident occurred in 20 % and 7.7 % of cases, anemia — in 80 % and 53.3 %, respectively, while mediastinal hematoma developed in 20 % of patients in group 1 only. 3. Risk factors for the development of acute kidney injury in the postoperative period were elevated urea levels and a history of chronic kidney disease. In patients of group 1, the level of intraoperative blood loss was 41.7 % higher than in group 2, but the differences were not statistically significant
Neoaortic Bicuspid Valve Replacement in Patient After Arterial Switch Operation to Correct Dextro-Transposition of the Great Arteries
No full textINTRODUCTION Transposition of the great arteries is the second most common cyanotic congenital heart defect after tetralogy of Fallot. The arterial switch procedure (А. Jatene, 1975) is the surgical treatment of choice. Neoaortic root dilatation and valve regurgitation are quite common among the patients who underwent surgery for transposition of the great arteries. However, there are a lot of conflicting data about their direct connection.CLINICAL CASE This article describes surgical repair of neoaortic bicuspid valve regurgitation, by it successful implantation, in an 18-year-old patient after arterial switch operation for transposition of the great arteries in the neonatal period.CONCLUSION Neoaortic valve insufficiency can develop primarily as well as secondary to neoaortic root dilatation, however, the questions about valve repair or aortic root replacement with or without neoaortic valve implantation remains debatable. At this stage, decision making is based only on unsystematic clinical experience, surgeon’s intuition, the basics of anatomy and pathophysiology, as well as close interaction of “pediatric” and “adult” cardiac surgeons
The Choice of Tactics for Surgical Treatment of Acute De Bakey Type I Aortic Dissection in a Multidisciplinary Surgical Hospital
No full textBACKGROUND Acute proximal aortic dissection (Stanford type A) remains the most common fatal pathology of the thoracic aorta. Despite the improvement of surgical technologies, hospital mortality after emergency surgical interventions is 17–25%, in complicated cases it can reach 80–90%.AIM OF STUDY Description of the perioperative treatment tactics adopted at the N.V. Sklifosovsky Research Institute for Emergency Medicine as well as the evolution of approaches that make it possible to obtain satisfactory hospital and long-term results in the treatment of aortic dissection.MATERIAL AND METHODS the study included 278 patients operated on from 2015 to 2021 in the acute stage of aortic dissection (less than 48 hours from the moment of manifestation of the disease). The operated patients were divided into two groups, depending on the presence of complicated forms: group A, 102 patients with uncomplicated course of the disease; group B, 176 patients with complicated course of the disease. Additionally, patients were divided depending on the level of distal reconstruction performed: group I, 83 patients, surgery was limited to prosthetics of the ascending aorta, without removing the clamp; group II, 137 patients who underwent hemi-arch surgery; group III, 58 patients, with distal reconstruction involving the aortic arch.RESULTS Total hospital mortality was 28.1%: 25.3% in group I, 29.1% in group II, 29.3% in group III. In the group of uncomplicated dissection, postoperative mortality was 18.6%, while in the group of complicated dissection it was 33.5%.CONCLUSION An integrated multidisciplinary approach with the formation of an “aortic team”, an individual approach to surgery, depending on the anatomy of the dissection and the clinical status of the patient, will improve the results of the treatment of acute aortic dissection, as the most severe and multiple organ pathology of the aorta.FINDING 1. Hospital mortality of complicated forms of dissection remains significantly higher — 33.5% versus 18.5% of uncomplicated course. 2. The most optimal method of distal reconstruction in patients with the peracute stage of dissection is an open anastomosis with the aorta using the “hemi-arch” technique. 3. If it is necessary to extend the surgical intervention on the aortic arch, a distal anastomosis in areas 0, 1, 2 with the possibility of a subsequent endovascular stage is the priority
The Successful Replacement of Aortic Valve and Ascending Aorta in Patients with Type A Aortic Dissection in the Postpartum Period. The Analysis of Literature and Demonstration of Own Observations
No full textAbstract. Aortic dissection is a rupture of the inner layer of the aorta with subsequent penetration of blood into the degeneratively altered middle layer with the formation of false lumen and true lumen. Pregnancy is one of the risk factors for the development of aortic dissection. The incidence of aortic dissection during pregnancy is only 0.0004% of cases.Aim of the study. To analyze national and foreign literature, as well as share own clinical observations in the diagnosis and treatment of patients with aortic dissection in the postpartum period.Material and methods. Two patients after successful childbirth, in the late postpartum period, were admitted with a diagnosis of aortic dissection type A according to Stanford.CT angiography confirmed the presence of Stanford type A aortic dissection. After additional examination, surgical treatment was performed to replace the aortic valve and ascending aorta under artificial circulation, with a satisfactory clinical result.Conclusion. The diagnosis of aortic dissection should be considered in all pregnant women with chest pain, as this condition often goes undiagnosed.The pregnancy period is one of the risk factors for the development of aortic dissection with a high mortality rate. The likelihood of developing aortic dissection in women at risk peaks in the third trimester and the first 12 weeks after delivery.The risk group should include women with confirmed syndromic and non-syndromic genetic diseases, bicuspid aortic valve, coarctation of the aorta, or at least one major criterion indicating the presence of aortopathy (ectopia lentis, aortic aneurysm, habitus, genetic testing).If Marfan syndrome is present, surgical intervention should be considered if the maximum aortic diameter is more than 4.5 cm before pregnancy. In women with Marfan syndrome and aortic dissection in the family history, as well as in the presence of more aggressive genetic diseases (Loeys-Dietz syndrome, Ehlers-Danlos syndrome), it is possible to consider preventive surgical treatment for an aortic diameter of 4.0 cm or more.The delivery in high-risk patients is recommended to be performed in a hospital that has a cardiac surgery service and an “aortic” team
