mehrab marzban

Acute and severe rises in systemic blood pressure during or after cardiac surgery may be life-threatening and result in end-organ injury. This case is the first report of spontaneous left atrial appendage rupture following a hypertensive crisis in cardiac surgery. Ethical approval for this report was obtained from the Ethics Committee.

Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain.. The current study describes for the first time our initial four-year experience of elective endovascular aortic repair (EVAR) at Tehran heart center, the first and a major referral heart center in Iran, as a pioneer of EVAR in Iran..Patients and A total of 51 patients (46 men) who had the diagnosis of either an abdominal aortic aneurysm (AAA) (n = 36), thoracic aortic aneurysm (TAA) (n = 7), or thoracic aortic dissection (TAD) (n = 8) who had undergone EVAR by Medtronic stent grafts by our team between December 2006 and June 2009 were reviewed.. The rate of in-hospital aneurysm-related deaths in the group with AAA stood at 2.8% (one case), while there was no in-hospital mortality in the other groups. All patients were followed up for 13-18 months. The cumulative death rate in follow-up was nine cases from the total 51 cases (18%), out of which six cases were in the AAA group (four patients due to non-cardiac causes and two patients due to aneurysm-related causes), one case in the TAA group (following a severe hemoptysis), and two cases in the TAD group (following an expansion of dissection from re-entrance). The major event-free survival rate was 80.7% for endovascular repair of AAA, 85.7% for endovascular repair of TAA, and 65.6% for endovascular repair of TAD.. The endovascular stent-graft repair of the abdominal and thoracic aortic aneurysm and aortic dissection had high technical success rates in tandem with low-rate early mortality and morbidity, short hospital stay, and acceptable mid-term free symptom survival among Iranian patients..

We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting. A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiac surgery at Tehran Heart Center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 (81.48%) of these patients. The patients’ age ranged between 20 and 84 years (mean: 58.33, SD: 10.08 years). Of the 1604 patients studied, 1186 (73.9%) were men, 592 (36.9%) had diabetes, 598 (37.3%) were smokers, and 194 (12.1%) cases had significant left main stenosis. Twenty-one (1.3%) patients had significant carotid stenosis (> 60% stenosis), which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 (1.4%) of the patients without carotid stenosis. Magnetic resonance angiography (MRA) was conducted in 15 patients. In our univariate analysis, female gender (p value = 0.023), hypertension (p value = 0.055), peripheral vascular disease (p value < 0.001), and age (p value = 0.001) were significant in the development of carotid stenosis. Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, female gender, and advanced age

The aim of this study was to evaluate the impact of diabetes mellitus (DM) on peripheral vascular disease (PVD) in patients with coronary artery disease (CAD). A total of 13702 consecutive patients who underwent coronary artery bypass grafting (CABG) at Tehran Heart Center between January 2002 and March 2007 were included in this study. The demographic data, PVD, and outcome of these patients were reviewed. CABG patients before surgery were detected for PVD (stenosis ≥70% in the abdominal aorta; renal, carotid, and iliac arteries; or any other peripheral vascular system) with physical examination and past medical history. The suspected cases of PVD were, thereafter, confirmed via Doppler sonography or invasive angiography. This study recruited 4344 diabetic patients (mean age 59.30±8.7 years) and 9358 non-diabetic patients (mean age 58.42±9.9 years). The diabetics were significantly older and had a higher incidence of PVD (2.7% vs. 1.8%), female gender, hypertension, renal failure, smoking, and dyslipidemia than the non-diabetics (P<0.05). There was no significant difference between the two groups with regard to family history and left main disease. Also, the mean ejection fraction (EF) was 48.85%±10.4 and 49.35%±10. In the patients with and without DM, respectively; and the difference was significant (P=0.008). The in-hospital mortality rate (mortality over a 30-day post-operative period) was 1.8% in the diabetics and 0.7% in the non-diabetics (P<0.001). In the multivariate analysis, PVD, left main disease, age, female gender, and EF were significant in the development of mortality amongst the diabetic patients with a respective odds ratio of 4.17, 5.54, 1.03, 2.86, and 0.95 (P≤0.050). In the multivariate logistic regression analysis, PVD was significantly higher in the diabetics than in those without DM (OR=1.283, 95% CI: 1.001- 1.644; P=0.049). In the diabetic patients, carotid (1.13% vs. 0.83%), subclavian (0.05% vs. 0.02%), femoral (0.18% vs. 0.09%), renal (0.62% vs. 0.25%), and tibialis (0.16% vs. 0.06%) arteries had a higher incidence of stenosis than those in the non-diabetics. We conclude that in diabetic patients with concomitant CAD, special attention must be directed towards the diagnosis of PVD using physical examination, Doppler sonography; and where needed, CT-angiography or invasive angiography. Also, in risk assessment, the presence of PVD should be strongly considered for CAD patients.

Prosthetic valve endocarditis (PVE) is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues (Duke criteria). The analysis included a detailed study of hospital records. The continuous variables were expressed as mean ± standard deviation, and the discrete variables were presented as percentages. Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients'' mean age was 46.9±12.8 years. Women made up 53.8% of all the cases. Early PVE was detected in 6 (46.2%) patients, and late PVE occurred in 7 (53.8 %). Eleven (84.6%) patients were treated with intravenous antimicrobial therapy, and the other two (15.4%) required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% (2 patients). It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk.

We compared the outcomes in patients with a low ejection fraction (EF) and multivessel coronary artery disease (CAD) who either underwent coronary artery bypass grafting (CABG) or received medical treatment (MT) after a viability study via dobutamine stress echocardiography (DSE) We considered patients with CAD and left ventricular ejection fraction (LVEF) <40% who were referred for DSE, and enrolled 106 patients (89% male, mean age: 55.8±9.7 years) with ≥4 viable segments. According to DSE, all the 106 patients were suitable for revascularization. We compared the outcomes between the patients who underwent CABG and those who received MT at a mean follow-up time of 8 months. Both groups had similar baseline characteristics and rest EF. Thirty-three (31.1%) patients underwent CABG and 73 (68.9%) received MT. There was no significant difference between the CABG and MT groups in terms of mortality rate (9.1% vs. 11.0 %) and improvement in New York Heart Association functional class at follow-up. In the CABG group, patients with LVEF ≤25% had higher mortality compared to patients with LVEF >25% (100% vs. 40%, P< 0.05). The patients with CAD and a low EF had the same survival rate after both CABG and MT at mid-term follow-up. Long-term follow-up is needed to show the survival benefit of CABG in such patients with an acceptable extent of viable myocardium.

The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery (HRR) in patients who received percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program (phase 2) after PCI (n=62) or CABG (n=178) at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR. All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors (except for diabetes mellitus) was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively (p=0.019). The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality (i.e. PCI or CABG) after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients.

Left ventricular dysfunction is one of the most powerful predictors of early and late outcomes in patients who undergo coronary artery bypass grafting (CABG). The aim of this study was to assess the early results of CABG that predict 30-day mortality and prolonged length of hospital stay (LOS) after CABG in patients with an ejection fraction (EF) of 30% or less. Seven hundred seven patients who underwent CABG with EF≤30% in Tehran Heart Center between January 2002 and January 2006 were entered and compared with 9467 patients with EF>30% as the control group. Demographic and clinical characteristics and postoperative complications were considered. The thirty-day mortality rate (2.3% vs. 0.8%, P<0.0001), the mean of LOS (P<0.0001), and the mean of the length of ICU stay (P<0.0001) were higher in the severe left ventricular dysfunction group than in the control group. In patients with severe left ventricular dysfunction, the mean of NYHA score (P=0.0081), prolonged ventilation (P=0.0051), and renal failure (P=0.0606) were related to the 30-day mortality rate. Also, the prolonged LOS in these patients was correlated with the female gender (P=0.0018) and atrial fibrillation (P=0.0164). Although left ventricular dysfunction is itself an important strong risk factor in patients undergoing CABG, the early outcome of CABG in patients with left ventricular dysfunction is acceptable and the management of this factor will help to reduce the mortality and total length of stay in hospital

Age is one of the most important factors that have consistently emerged as the most potent predictors of mortality and morbidity after coronary artery bypass graft (CABG) surgery. However, early results of CABG in young patients in comparison with elderly ones have been different in previous surveys. The aim of this study was to compare short-term mortality and morbidity in young versus older patients and evaluate the presence of risk factors and their influence on outcome in both groups. We conducted a retrospective database review of 13222 patients divided into two age groups: patients less than 40 years old (411 patients) and those older (12811 patients), who underwent CABG at Tehran Heart Center between January 2002 and January 2007. We also compared preoperative, operative, and postoperative characteristics between them and assessed the influence of the variables on the length of stay in hospital (LOS) in the two groups. Among postoperative complications, only atrial fibrillation (P<0.001) was more prevalent in the elderly group and other complications were similar. The thirty-day mortality rate was higher in the elderly group (1.1% vs. 0%, P=0.023). Also, prolonged LOS (P<0.001) and ICU stay (P<0.001) were found more prevalent in the elderly group. Among the preoperative and postoperative variables, emergency surgery, diabetes mellitus, and previous myocardial infarction influenced the prolonged LOS in the young patients. Early mortality rate and prolonged length of stay in ICU and hospital were higher in the elderly than those in the young patients; however, other postoperative early complications were similar between the two groups.

Obese patients are usually thought to have an increased risk for complications in coronary artery bypass grafting surgery (CABG). Several studies have been unclear about the relationship between obesity and the risk of adverse outcomes. The aim of this study was to assess the relationship between Body Mass Index (BMI) and in-hospital mortality following CABG. Between December 2003 and February 2005, 1258 patients who underwent isolated CABG at Tehran Heart Center were included in this study. Patients were divided into three groups according to their BMI. Patients in group I had BMI<30 (non obese patients). In group II patients had (obese patients). Patients in group III had (very obese patients). Patients in each group were followed for in-hospital death and variables were compared to find any statistically meaningful relationship. No significant difference was found between non obese and obese patients (group I & II), but hypertension was more prominent in very obese patients (group III) and female sex was more prevalent in this group comparing two other groups. Mortality was more in the 3rd group as well. In non obese diabetic patients, the rate of mortality was higher than other patients. Logistic regression showed that BMI can not be considered as an independent factor to predict the risk of death in post CABG in-hospital mortality. It seems, in coronary artery bypass grafting, BMI is not an independent factor for predicting in-hospital mortality.

Dialysis patients frequently have coronary artery disease but are regarded as high risk patients for coronary artery bypass grafting (CABG). Between February 2002 and September 2006, seventeen dialysis-dependent patients underwent isolated CABG at our center. CABG was performed under cardiopulmonary bypass (CPB) for all the patients. All cases had been maintained on hemodialysis and the duration of preoperative hemodialysis ranged from 6 to 24 months (mean 13.4±6.4). The patients’ characteristics, clinical and operative data as well as perioperative and mid-term outcome were reviewed. All patients were men with a mean age of 53±8.4 years. Mean preoperative ejection fraction was 45.5%±10.4% (range 25 to 60 %). One internal mammary graft was used in 16 (94.1%) patients. Cardiopulmonary bypass and aortic cross-clamp times were 71.3±18.7 and 40.5±8.3 minutes respectively. The more frequent complication was prolonged mechanical ventilation in 2 (11.7%), there was no perioperative mortality. In mid-term follow-up (mean time: 11.8±9.5 months) the mid-term mortality rate was 20% (3 patients). CABG in chronic renal dialysis patients can be accomplished with acceptable short and mid-term morbidity and mortality.

A 56-year-old man with a two year history of chronic stable angina underwent elective coronary artery bypass grafting (CABG) due to angiographic report of three vessel disease and tight stenosis at proximal part of left anterior descending artery (LAD). While harvesting of radial artery (RA), the distal half of radial artery was found to bifurcate to two parallel branches with equal size. We used this as a single conduit to bypass the first and second obtuse marginal (OM) branches. The patient had a smooth post-operative course and uneventful recovery.

Obese patients are usually thought to have an increased risk for complications in coronary artery bypass grafting surgery (CABG). Several studies have been unclear about the relationship between obesity and the risk of adverse outcomes. The aim of this study was to assess the relationship between Body Mass Index (BMI) and in-hospital mortality following CABG.
Between December 2003 and February 2005, 1258 patients who underwent isolated CABG at Tehran Heart Center were included in this study. Patients were divided into three groups according to their BMI. Patients in group I had BMI No significant difference was found between non obese and obese patients (group I & II), but hypertension was more prominent in very obese patients (group III) and female sex was more prevalent in this group comparing two other groups. Mortality was more in the 3rd group as well. In non obese diabetic patients, the rate of mortality was higher than other patients. Logistic regression showed that BMI can not be considered as an independent factor to predict the risk of death in post CABG in-hospital mortality.
It seems, in coronary artery bypass grafting, BMI is not an independent factor for predicting in-hospital mortality.