فهرست مطالب kambiz alizadeh

Coping with climate change (CC) is part of the way to face this phenomenon. This depends on the understanding of CC and the degree of adaptability to it.

The research was conducted with the aim of measuring the level of nomads' understanding (NU) of CCe and their adaptation strategies (AS) in the face of CC.

The research was descriptive and the data collection tool was a questionnaire whose items were obtained based on interviews.

NU of the effects of CC is not the same. According to them, CC has had the most obvious impact on vegetation. The priority of AS is also different in the face of CC. A positive relationship was observed between understanding the effects of CC and the degree of adaptability in facing CC. Nomads who had a better understanding of the effects of CC have used livestock management strategies to adapt to it. Age and history of animal husbandry had a positive relationship with the level of understanding of the effects of CC. A negative and significant relationship was also observed between the number of animals and the degree of compatibility.

The NU of CC and its effects on the ecology of the environment is an important starting point in dealing with the negative effects of CC and choosing appropriate strategies to adapt or deal with it. So that the selection of suitable adaptation methods by the nomads reduces the vulnerability of CC on the condition of livestock and rangeland.

The answer to what is the experience and indigenous knowledge of pastoralists and nomads about the rangeland management and how to apply the existing knowledge in rangeland management plans, is one of the important topics of rangeland management. In this regard, indigenous mechanisms of grazing management in the semi-desert rangeland of southeastern of Isfahan were investigated. The research method was qualitative and while conducting in-depth interviews and collecting information, key questions were determined about how management and livestock grazing behavior. Summarizing the statements of the interviewees and library sources, showed that; livestock grazing behavior in different months of the grazing season is different; in terms of movement speed and the hours of the herd's presence in the rangeland, sources of nutrition, the amount of fodder required and amount of fodder consumption and is strongly influenced by the quantity and quality of fodder and plant composition. Herd management during the grazing season is done with two systems of continuous grazing and rotational grazing system. The choice of grazing system is related to predominance of species and the amount of harvestable fodder and management goals. During the cold months of the year, the continuous grazing system is used, and as the weather gets warmerand favorable conditions for the regrowth of plants, the rotational grazing system is used. which is considered the number of grazing plots in each rangeland 28 and the number of grazing times per plot twice a year. The grazing period in each plots is considered to be one day and the resting period is four days. Total Digestible Nutrients (TDN) in the area of 5000 hectares of the researched rangeland area is equal to 141157 kg and the amount of TDN demand is 146361 kg. With these conditions, there are in the months of December, January, February and March, respectively, the fodder deficit is 29.5, 28.5, 22.8 and 11.3% and in the period of plant growth (April and May), 51.6 and 3.6% of surplus fodder. In total, the mentioned systems, which are designed and implemented through the experience and indigenousknowledge of rangeland management and with the aim of establishing a balancing fodder with the daily needs of livestock in different months of the grazing season; it is consistent with the principles and foundations of modern range management knowledge, that if included in rangeland plans, while providing the basis for the participation of users in the preparation and implementation of rangeland plans, will also provide more success for the plans.

Coronary artery bypass grafting (CABG) is one of the most common surgical methods in patients with coronary artery disease, a well-known complication of which is renal injury after surgery. Here we try to understand the factors involved in the incidence of acute renal injury in our patients. The aim of this study was to evaluate the incidence and etiology of acute kidney injury (AKI) following CABG. This study was performed on 181 patients undergoing CABG surgery. AKI was also recorded after registering demographic information and clinical indications. Chi-square, Mann-Whitney and independent t-tests were used for data comparison. The findings of our study showed that AKI following CABG in our patients was 3.9% which had no significant relationship with age, sex, hypertension, diabetes, type of surgery, hypercholesterolemia, number of clogged arteries, smoking and length of surgery; however,blood, urea was found to be significantly higher preoperatively in patients with AKI. The results of our study revealed that AKI following CABG in the studied patients was 3.9%, which was not significantly related to age, sex, hypertension, diabetes, type of surgery, hypercholesterolemia, number of clogged vessels, smoking and the length of surgery. although, the urea was observed to be significantly higher in patients with AKI before surgery. Studies with larger sample sizes are recommended.

Obstructive sleep apnea and snoring are associated with high blood pressure, stroke, and cognitive impairment, as well as increased risk of perioperative heart events and respiratory failure. This study aimed to investigate the association between snoring and pulmonary complications after coronary artery bypass graft surgery.Methods and Materials: In this cross sectional study, 232 participants referred to two general hospitals in Mashhad, Iran from Dec 2017 to Jan 2018 for coronary artery bypass surgery were categorized to two groups of snoring and non-snoring. For each participant, a checklist including demographic information, snoring history, medical history, lung complications and laboratory findings were completed. In addition, three snoring questionnaires including STOP-BANG, Berlin and Epworth were filled out. The results showed that there were no statistically significant differences between groups in term of age (P = 0.404). There was a significant difference in oxygen saturation, duration of extubation, and length of stay in ICU and surgery ward in the snoring group. The mean score of the snoring group was significantly high according to Epworth scale (P = 0.001). Based on the Berlin and STOP-BANG questionnaire, participants with snoring had a significant risk of apnea and obstructive sleep apnea (p=0.008 and p=0.001, respectively). There was no significant difference between the history of diseases such as hypertension, diabetes, and hyperlipidemia (p>0.05). In conclusion, snoring increases oxygen desaturation, time required for extubation, and the length of stay in hospital in patients scheduled for coronary artery bypass graft surgery.

Liver resection requires time management due to the high risk of bleeding. Plant-based materials are superior to other agents in  reducing complications during hemostasis. This present study aimed to investigate the effect of plant-based topical hemostatic nanoparticles from the rosaceous as an innovative hemostatic agent.

Twenty male Wistar rats were randomly divided into two study groups. All rats were anesthetized and their anterior lobe of the  liver was amputated. The incision site was directly pressed with a dry gauze for 2 minutes in the control group and repeated every
30 seconds until hemostasis was achieved. Homeostatic material was compressed on the incision site and clotting time was  recorded in the intervention group. The mean hemostasis time was compared in both groups using Paired Samples Test. P <0.05
was considered statistically significant.

Hemostasis was successfully achieved in both groups. The hemostasis time were 6.7±1.33 and 183±26.26 in Nanoparticles and  control groups, respectively and their differences were significant (P<0.001). Histopathology evaluation indicated a slight increase  in vascularity, fibrosis, and polymorphonuclear neutrophil (PMN) infiltration in one case. Mild to moderate lymphocyte  infiltration was detected in 2 cases.

The produced plant-based Nanoparticles could significantly reduce the hemostasis time in the intervention group compared to that  of the control one.

Surgical site infection is a risky complication following coronary artery bypass graft (CABG) surgery that may increase mortality and morbidity. Hence, it seems that further investigation regarding this complication may be necessary, in order to improve prevention and treatment processes. The aim of this study was to determine the frequency of sternal wound infection and saphenous vein wound infection in patients undergoing CABG and its correlation with the determinants. This is a cross-sectional study that was undertaken from 2015 to 2019 on 2459 patients undergoing CABG surgery with off-pump and on-pump methods. Demographic and background information of our patients were recorded. After infection, secretions were sampled and cultured. Results of the study showed that the frequency of sternal and saphenous harvesting site infection in patients was 3.7% (n=91), and these infections were often diagnosed two weeks after surgery (50 patients, 54.9%). Age and sex were identified as two significant risk factors of surgical site infection after CABG surgery (p=0.0001). Most patients came back with an infection two weeks after surgery (54.9%). Gram-positive bacteria had the greatest role in infection (35.2%) with Staphylococcus epidermidis acting as the predominant strain (n=13).Discussion and The results suggested that two factors with a crucial role in the incidence of infection, are female gender and age of 50-60 years old. Diabetes, previously identified in the literature as a risk factor for surgical site infection, did not have a significant effect in this study and further research is warranted.

Although most of the Coronary Artery Fistulae to venous system are congenital , we present a case who was treated conservatively and developed an acquired post CABG fistula formation between Right Coronary Artery and Superior Vena Cava that due to with allow-flow shunt and few symptoms. Case presentation We present a 65 year-old man with history of CABG 3 years earlier who present with chest pain. He had developed a 3-vessel diseases well as a recent Myocardial Infarction (MI) with reduced EF (EF= 25%) he presented a Chest Discomfort since 2 month after discharge that increasing by any physical activity. Consultant Cardiologist decided to perform Coronary Angiography to assess the condition of Native Coronary Artery and also Coronary Grafts well. on coronary angiography all of grafts was patents and but there was an abnormal communication between proximal of native Right Coronary Artery and Superior Vena Cava that finally fill the Right Atrium. Conclusion Clinically, although most of Coronary Artery Fistulae are silent and asymptomatic due to Limited amount of shunt, but in some rare cases in which there is a large shunt and steal of coronary circulation, symptoms and signs of Ischemic Heart disease appears that there are surgical and interventional options for closure of this abnormal communications.

Implantation of prosthetic valve requires a life time consumption of anticoagulation. Thrombotic and embolism complications as well as bleeding associated with anticoagulants are the leading cause of mortality and morbidity after heart valve surgery. Accordingly, this study is designed to explore and report the complications and factors related to usage of warfarin and constant check of prothrombin time and international normalized ratio.

This is an observational study in which the medical records of 100 patients with an average age of 47.9 ± 13.4 years undergoing surgery for replacement of heart valves were studied. All factors related to mortality and postoperative complications were extracted, and the patients were followed up for one year.

The results suggested that tricuspid valve insufficiency was significantly correlated other valvular defects. Nine patients died; one patient in the operating room, one patient in the ICU, one patient in the ward and six patients during the first year died after the surgery. Two of the patients needed redo-surgery in the first year. It should be noted that among patients receiving warfarin on a regular basis (n=81), no mortality was reported in a one-year fallow-up.

In this study, out- of-hospital mortality only occurred in patients' irregular usage of warfarin and without follow-up coagulation tests. So, we conclude that in developing country, if we cannot follow and train the patients constantly for warfarin usage and blood tests, mechanical valve utilization would be concomitant with high risk complications.

This study aims to investigate the role of coronary artery bypass graft (CABG) surgery by off-pump and on-pump methods in the severity of postoperative inflammation based on serum levels of interleukin 6 (IL6) and interleukin 17 (IL17). This is a cross-sectional study in which 39 patients’ candidate for CABG were evaluated in terms of serum levels of IL17 and IL6 before and after surgery in two groups of off-pump and on-pump CABG. Thirty-nine patients with an average age of 63±8.9 in the on-pump group and 59±7.74 in the off-pump group were evaluated. There was no significant difference between the two groups in terms of baseline information and underlying diseases. IL6 serum level (p=0.249) was not significantly difference between the two groups. However, IL17 serum level (p=0.012) demonstrated a significant difference between the two groups. In general, the results of this study showed that increased IL6 serum level following coronary artery bypass was not different between the two methods of CABG surgery. Besides, IL17 exhibited a significant difference between the two groupsi that it was reduced in on-pump group in after surgery. It can be due to special condition’s patients or low sample size of study. Moreover, the postoperative complications were not significantly different between the two groups. This valuable outcome contradicts the popular belief that the use of the CARDIO PULMONARY BYPASS (CPB) system stimulates the immune system and hence its application should be limited.

Ischemic postconditioning is a novel strategy for attaining cardioprotection. Remarkable evidence from various in vitro and in vivo animal and human studies have shown significant opioid-induced cardioprotection against myocardial ischemia/reperfusion (I/R) injury. The purpose of this study was to assess the cardioprotective effect of sufentanil against I/R injury after on-pump coronary artery bypass grafting (CABG).

Between June 2016 and July 2017, 80 consecutive patients with triple-vessel disease undergoing on-pump CABG were enrolled in this prospective randomized study. The patients assigned to the sufentanil group received a single dose of sufentanil (0.2 μg/kg diluted with 50 cc of saline) 5 minutes before the removal of the aorta cross-clamp, with the sufentanil injected via a cardioplegia needle into the aortic root. In the control group, the same volume of normal saline was injected as a placebo. Cardiac enzymes, the inotrope score, and the outcome data were compared between the 2 groups.

The mean age of the patients was 60.48±7.50 years (range=41–69 y), and men comprised 65.0% of the study population. The levels of CK-MB and cardiac troponin I were significantly lower in the sufentanil group (P<0.001). The amount of inotrope use (P<0.001), the incidence of atrial fibrillation (P=0.014), electrical shock (P=0.007), and the mechanical ventilation time (P<0.001) decreased in the sufentanil group compared with the control group. However, the use of intra-aortic balloon pumps (P=0.247) and the ICU length of stay (P=0.867) were not significantly different between the 2 groups.

The injection of a single dose of sufentanil into the aortic root prior to aorta cross-clamp removal diminished cardiac injury during on-pump CABG in our patients.

Breast cancer is one of the most common cancers in women. As we know, cardiac metastases occur rarely. In this study, a 40-year-old woman referred to the hospital due to severe pain in the right leg. She was diagnosed with deep vein thrombosis (DVT) and received treatment, but, after one month and a half she returned with severe pain, exacerbated shortness of breath, cramping pain, and chest pain. With the diagnosis of lung embolism, she received anticoagulant therapy and discharged after recovery. Then, about two months later, the patient was admitted for the third time, with symptoms of shortness of breath, chest pain, and right foot edema. In Doppler echocardiography, acute to chronic thrombosis was reported in femoral popliteal vein and common femoral vein with external liliac expansion. Based on the computed tomography angiography (CTA) and Echocardiography, the patient was diagnosed with pulmonary embolism with a mass in the right ventricular, so, cardiothoracic surgery consultation was done. During the operation, extensive spread of metastasis was seen on mediastinum, the aorta, and pericardial space. A biopsy was performed and metastatic breast cancer was reported. This study signifies the importance of examining patients with recurrent DVT for malignancy.

  Cystic hydatidosis is a zoonoticdisease thatis mostly observedin the Mediterranean region. This infectious disease may present throughdifferent manifestations that may delay the diagnosis and cause various complications for the patients. Most of the cases are usually diagnosed by imaging studies and the related management could be medical or surgical depending on the patient’s clinical condition and disease severity. In the present report, we present the case ofa 50-year-old female patient with a positive history of liver and splenichydatid cysts with hemoptysis and dyspnea. The diagnosis of pulmonary and cardiac involvement wasmade usingcomputed tomography angiography. Despite the immediate surgery, the patient died from hemorrhage after 3 days. Themanagement of pulmonary embolism due to Echinococcus highly depends on the clinical judgment and the outcomes are subject to the history and extent of the involvement.

Postoperative cognitive decline is a common complication observed frequently after general anesthesia in the immediate postoperative phase. We studied the effects of dexmedetomidine versus midazolam during coronary artery bypass graft (CABG) surgery on cognitive and memory function.  In this clinical trial, 42 elective on-pump CABG candidates under general anesthesia, aged between 40 and 65 years, were enrolled randomly in 2 groups. Group A received 0.05–0.1 mg/kg of midazolam and Group B received 1 µg/kg of dexmedetomidine. One day before surgery, all the participants underwent the Persian version of the Mini-Mental State Examination (MMSE) and the Persian version of the Wechsler Memory Scale (WMS) test for a comparison of cognitive impairment and memory functions. Both groups were given fentanyl and propofol for the induction of anesthesia and muscle relaxants. The MMSE and WMS tests were repeated 5 and 30 days after surgery. The mean±SD of age was 55.47±7.18 y in Group A and 55.39±6.08 y in Group B. Eighty percent of the participants were men in both groups. There were no significant differences between Group A and Group B in the MMSE and WMS before surgery (89.04±14.30 vs. 97.10±18.10, respectively;  P=0.059), but the WMS was significantly different 30 days after surgery (87.60±14.30 vs. 103.53±19.93, respectively; P=0.005). Group A showed high cognitive impairment and low WMS scores compared with Group B (P=0.005). Additionally, the MMSE results were not statistically different between the 2 groups postoperatively (24.80±3.18 vs. 23.55±4.18, respectively; P=0.394). Our results showed that dexmedetomidine might have a lower impact on cognitive function than might midazolam among patients undergoing CABG.

Abstract Pericardial effusion is the accumulation of over-normal fluid in the pericardial space that is pathologic and causes cardiac dysfunction and sometimes death of the patient. We aimed to evaluate the etiology and mortality of pericardial window patients. A retrospective descriptive analysis was performed on all the patients with cardiac tamponade, who were admitted to cardiac surgery ward of Ghaem Hospital during 2013-2017. We included patients who had undergone transthoracic echocardiography by the cardiology service at least once. After completing the forms specific to information and considered variables, SPSS was used to analyze the data. P-values less than 0.05 were considered statistically significant. Of the 100 patients, 45 were female and 55 were male. The mean age of the patients was 57 years. The most common etiologies included viral infections (25%), tuberculosis (10%), malignancy (6%), chronic kidney diseases (4%), connective tissue disorders (4%), chronic liver diseases (3%), and history of open heart surgery (3%). In 45% of the cases, a specific etiology could not be established. The rate of mortality was reported 2%. Pericardial effusion and cardiac tamponade are life threatening conditions. However, timely medical intervention and surgery, as well as proper operative management, can effectively save lives and reduce patient mortality.

Galectin-3 is known as a biomarker in patients with heart failure. This protein participates in different mechanisms involved in atherosclerosis including inflammation and plaque formation. This study was conducted to investigate whether this factor could be a predictive biomarker for the severity of atherosclerosis. The study group consisted of 80 patients with coronary atherosclerosis referred to the Department of Cardiac Surgery of Ghaem Hospital, affiliated to Mashhad University of Medical Sciences, Mashhad, Iran. The serum level of galectin-3 was measured using a commercial enzyme-linked immunosorbent assay kit. The severity of coronary artery disease (CAD), evaluated by the serum levels of galectin-3, was expressed as the number of involved vessels. Galectin-3 concentration was directly correlated with the number of involved vessels.The serum level of galectin-3 was significantly higher in patients with four involved vessels (20.76±7.20 ng/ml) than those with three-vessel disease (14.31±4.45 ng/ml; P<0.001). Patients with three-vessel disease had higher levels of galectin-3 than patients with one and two involved vessels (7.20±4.09 ng/ml; P<0.001). The relationship between the number of vessels involved and the concentration of Galectin-3 was statistically significant. According to the results, serum galectin-3 level is considered as a noninvasive tool for the diagnosis of preliminary assuming the coronary artery involvement. Although this study needs further detailed investigations with preferably larger sample size, the results of the present study highlighted the importance of this factor in CAD. This protein can help in early evaluations for preliminary determining the prognosis before the complementary aggressive intervention

This paper intends to evaluate the effects of on-pump beating-heart coronary artery bypass graft (CABG) in patients with coronary artery disease. Studies have shown that this surgical procedure can have acceptable results.

This study intends to share experiences and results of on-pump beating-heart CABG.

We reported preliminary results related to mortality and morbidity in patients who underwent CABG in the period from 2015 to 2017 in Ghaem hospital, Mashhad, Iran.

80 patients, in the period from 2015to 2017, underwent general anesthesia and on-pump beating-heart CABG surgery was done for them. The average number of grafts was 3.18± 0.474 and two patients died, unfortunately: one during surgery and one in ICU. There were no postoperative myocardial infarctions during the study. None of the patients reported kidney dysfunction. The average length of hospitalization was 4±1.11 days and the mean follow-up of the patients was 6 months. The average ejection fraction (EF) of patients was 43. 28± 9.58.

In the last decade there has been a big challenge between using off-pump CABG and on-pump CABG, on-pump beating method could present acceptable and effective results.

Coronary artery disease (CAD) is a multifactorial problem. Although hyperlipidemia (HLP), diabetes (DM), and hypertension (HTN) are known as the familial and cardiac risk factors, CABG is rare in the several members of a family. We reported the six members of a family who presented with MI and/or advanced angina pectoris during the 6 years. CABG(Coronary artery bypass graft) considered for all patients due to involvement in main coronary arteries and clinical presentation. The ejection fraction (EF) was varied between 25% to 70%. Beating heart cardiopulmonary bypass (beating heart CPB) and off-pump were chosen as surgical method. The mean duration of surgery was about 4 hours. The only post-operative complication was deep wound infected in a young man who was smoker and drug abuser. According to family relationship of patients and the high effect of genetic penetration, we presume the gene influence to incidence CAD and potential to undergoing CABG, in members of a special family.

There are different approaches to reduce the amount of blood loss and allogenic transfusion in cardiac surgery. Regarding this, the present study aimed to evaluate the blood sparing effect of acute normovolemic hemidilution (ANH) combined with intrao-perative tranexamic acid in patients undergoing off-pump coronary artery bypass (OPCAB).
Material and This study was conducted on 80 consecutive patients scheduled for elective OPCAB. The patients were randomly subjected to tranexamic acid treatment (TA group) or to tranexamic acid plus ANH (ANH group). All data, including demographic information, allogenic transfusions (based on a prior defined criteria), amount of postoperative bleeding, and major complications, were recorded.
According to the results, the two groups were comparable in terms of the demographic data and intraoperative variables. The mean values of postoperative bleeding were 483±125 and 580±201 mL in the TA and ANH groups, respectively, indicating no significant difference between them in this regard. Total transfused packed red blood cells (PRBC) used in the TA and ANH groups were 15 and 20 units, respectively, which revealed no significant difference between the two groups in this respect (P=0.23). Furthermore, 12 and 10 patients in the TA and ANH groups were transfused with PRBC, respectively. Moreover, the two groups showed no significant difference in terms of the postoperative hematological variables (P>0.05).
As the findings of the present study indicated, ANH was not effective in reducing postoperative bleeding and the need for allogenic blood products in the patients undergoing OPCAB.

Video-assisted thoracoscopic surgery (VATS) has been shown to be a safe and effective method for the patent ductus arteriosus (PDA) closure. This study aimed at evaluating the patients with PDA who underwent the VATS closure.
In this retrospective descriptive study, the medical records of 129 patients with the mean age of 35.44 months who underwent VATS were assessed during 2003 - 2016. Demographic data, mortality rate and surgery events were also recorded and reported.
The results showed that 9.3% of the patients had conversion to thoracotomy and less than 2.3% (3 cases) of the patients developed pulmonary complications: two chylothorax and one residual shunt. The mortality rate of these patients was zero.
Results of this study showed that the PDA surgery using the VATS method could reduce the mortality rate, complications and side effects.

Stanford type A acute aortic dissection (AAD) is a very rare complication, with potentially lethal consequences in pregnancy. In fact, pregnancy has been regularly associated with the possibility of aortic. dissection in almost half of young women. Herein, we present the case of a 38-year-old woman in her 37th week of pregnancy. The patient’s medical history was indicative of G4L2Ab1(4 gestaitions,2 lives, 1 abortion). She developed persistent chronic pain in the neck, chest, and back, without nausea or vomiting while waking in the morning. The computed tomography angiogram was indicative of AAD. The medical decision was to perform a combination of cesarean section under general anesthesia and median sternotomy for the open aortic valve. The term newborn showed an Apgar score of 9-10. The coronary arteries were preserved and the valve was repaired at commissural positions. Dacron supracoronary tube graft was attached to the aortic anastomotic site and subsequently to the aortic arch. The patient was discharged on day three after surgery with a good general condition. Moreover, the results indicated that she and one of her brothers suffered from Marfan syndrome.

Cardiopulmonary bypass in pregnant patient is considered a high-risk procedure. Maternal mortality is similar to that of the non-pregnant females about 1.5-5%. Variations in the timing of surgical intervention, gestational age, maternal health sta­­­­tus, perfusion protocol, and pharmacologic therapy are all factors that can influence fetomaternal outcome.
Case Report: We present a case of 26- year- old pregnant woman (G1, Ab0, D0) in gestational age of 36 weeks with sudden CVA and neurological sequelae (disartheria, paresthesia of right side of face). In her past medical history, she had no positive history of neurologic problems, diabetes mellitus, hyperlipidemia or cardiovascular diseases. Left perisylvian encephalitis was reported in her brain MRI. In trans-thoracic echocardiography moderate Mitral Regurgitation (MR), severe mitral stenosis with gradient of 9mmHg, and valve surface of 1cm2 was observed. In obstetrics consultation, a healthy male fetus with approximate gestational age of 37 weeks was reported. Finally the pregnancy ended by caesarean section under general anesthesia, with presence of cardiologist and a healthy newborn was delivered at age of 37 weeks. Four days after caesarean section, Mitral Valve Replacement (MVR) was measured which proceeded successfully.
Due to the risk of further neurological complications in a pregnant mother who suffers from mitral valve stenosis, provided the gestational age permits harmless termination of pregnancy, it is possible to perform the mitral valve replacement procedure during the same hospital stay after termination of pregnancy.

Pulmonary embolism is one of the leading causes of mortality in patients.The mortality rate of this disease can be significantly reduced with appropriate treatment. Surgical intervention can be highly effective for the treatment of acute massive pulmonary embolism. This article presents a report on the experience of acute pulmonary embolectomy.
Demographic data, rate of mortality, as well as surgical and post-operative complications were recorded and analyzed.
In general, 12 patients with mean age of 60±13.39 year were included in the study. None of the patients had significant arrhythmia during the surgery, but 25% suffered from post-operative arrhythmia. Moreover, electrical cardioversion was administered to 8% of the patients, 8% received pharmaceutical interventions, and the rest of the patients sustaining arrhythmia (9%) survived with specific metabolic correction.
The diagnosis of acute pulmonary embolism was correct in 100% of the patients, with 33.3% of the cases suffering from this disease due to recent surgeries. In 41.6% of the patients, blood clots were observed in the pulmonary artery, right atrium, and right ventricle. The three-month follow-up of the patients showed that 83.3% of the cases were alive. There were two cases of mortality, one of which occurred at the end of surgical procedure and the other one happened in the intensive care unit.
The results of independent t-test did not indicate any significant relation between mortality and ejection fraction of the patients (P=0.189). Moreover, there were not any significant differences between the patients’ pre- and post-operative laboratory tests (P˃0.05). Nonetheless, hemoglobin and hematocrit levels were significantly different pre- and post-operation (P=0.0001).
Our data suggest that acute pulmonary embolism can be treated successfully with favorable outcome and a mortality rate of approximately 16.6%, if evaluation and diagnosis are done as soon as possible in patients who require surgical intervention.

Insome cases, assist devices are required to ensure an adequate cardiac output after cardiac surgery. Intra-aortic balloon pump (IABP) is the most commonly used cardiac assist device, which provides first-line support for patients with heart failure. The aim of this study was to determine factors affecting the mortality rate of patients receiving IABP. In this retrospective cohort study 235 patients requiring LABP support were analyzed over 14 years period (between January 1999 and December 2013) from which 137 patients survived the 30 days follow-up. Perioperative and demographic factors such as age, weight, underlying disease, ejection fraction, ventricular aneurysm and cardiopulmonary bypass and cross clamp time were recorded and analyzed. The overall operative mortality was reported to be 41.7%. Male-to-female ratio was 131:104 and the mean age of the subjects was 57.58 ± 11.07 years. Early mortality rate was higher among young subjects and those with prolonged CBP (162.71±35.25, P<0.001) and ACC (129.94±54.39, P<0.001). In addition, mortality rate was higher among females (P=0.04). Patients’ weight, comorbidity, preoperative ejection fraction, ventricular aneurysm and stenosis of the left main coronary did not affect the mortality rate (P>0.05). IABP is a simple, effective method for temporary cardiac support, especially for aged patients. In addition, lower duration of surgery is associated with better surgical outcomes.

Coronary artery disease (CAD) is the most common type of heart disease, with a mortality rate of 385,000 person per year in the United States. There are two main methods for CAD treatments: angioplasty and bypass surgery. Coronary Artery Bypass Grafting (CABG) is one of the greatest surgical operations of the 20th century and it is presented as most effective and long-term therapies in the treatment of ischemic heart disease. There are two different methods of CABG; on-pump and off-pump. While off-pump CABG is a newer method, it decreases stroke and maintains higher mental function. We conducted the assessment of patients’ outcome that underwent on- or off-pump CAGB with hemodynamic instability. In this cross-sectional study, we evaluated cardiogenic shock patients with CABG who referred to Ghaem hospital for emergency operation from January 2012 to November 2013. We collected medical records archive from this hospital and all patient's information including demographic data, clinical variables, and past medical history separately. We performed on and off-pump CABG surgery for the patients. In on pump group, we performed beating on pump method, without aortic cross clamping. Twenty-eight patients who underwent CABG in two forms: on-pump and off-pump were studied. The minimal age of the patients was 34 and the maximal was 78. Patients’ weight had a range between 60 to 95 kg. The minimum used graft were two and the maximum were five. Ejection fraction was diversified between 15% (min) and 50% (max). Operation time ranged 1.50 to 5.50 hours. The ICU stay time was between 2(min) to 11 (max) days. Finally death was occurred in 5(17.9%) of patients. Our findings showed that CABG with beating heart could increase the survival of hemodynamic unstable patients in comparison with off-pump CABG

Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB). Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies) that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used.