Moderate ischemic mitral incompetence: does it worth more ischemic time?

Background: To evaluate the early results of operation for partial atrioventricular septal defect. Methods: Twenty-sevent patients underwent surgical correction of partial atrioventricular septal defect from 1/2011 to 12/2013 at Cardiovascular Centre of Hue Central Hospital. There were 7 (25.9%) female patients and 20 (74.1%) male patients, 18.5% of patients aged < 1 age, 55.6% of patients aged ≥ 1 to 15 years, and 25.9% of patients aged ≥ 16 to 60 years. Sevent (25.9%) had congestive heart failure. There was a primum atrial septal defect in 100% of patients. A cleft of the anterior mitral leaflet was diagnosed in 100% of patients. 92.6% of patients had either moderate or severe mitral incompetence prior to operation. The pulmonary artery systolic pressure exceeded 40 mmHg in 85,.2% of patients. Results: Atrial septal defects were closed with a pericardial patch in 100% of patients. The cleft in its anterior leaflet was closed in 100% of patients. Postoperatively, moderate mitral insufficiency developed in 14.8% of patients. 85.2% of patients have mild mitral incompetence. One patients (3.7%) needed a permanent pacemaker. There was no intraoperative mortality. At 6-9 months postoperatively, left atrioventricular valve insufficiency was moderate in 2 (7.4%) patients and mild in 25 (92.6%) patients who had had cleft closure alone. Conclusions: Repair of partial atrioventricular septal defect is safe and good. It is important to close the cleft in the left atrioventricular valve. The mitral valve should be repaired in a conservative manner. Intraoperative complications occur but are uncommon, suggesting that short-term follow is excellent.

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Ischemic Time-Dependent Microvascular Changes and Reperfusion Injury in the Rat Small Intestine

Journal of Surgical Research ◽

10.1006/jsre.1995.1170 ◽

1995 ◽

Vol 59 (2) ◽

pp. 311-320 ◽

Cited By ~ 32

Author(s):

Mihály Boros ◽

Shigeko Takaichi ◽

Kaoru Hatanaka

Keyword(s):

Small Intestine ◽

Reperfusion Injury ◽

Time Dependent ◽

Rat Small Intestine ◽

Ischemic Time ◽

Microvascular Changes

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Impact in total ischemic time and ST-segment elevation myocardial infarction admissions during COVID-19

The American Journal of Emergency Medicine ◽

10.1016/j.ajem.2021.02.020 ◽

2021 ◽

Vol 45 ◽

pp. 7-10 ◽

Cited By ~ 1

Author(s):

Sharon Bruoha ◽

Chaim Yosefy ◽

Enrique Gallego-Colon ◽

Jonathan Rieck ◽

Yan Orlov ◽

...

Keyword(s):

Myocardial Infarction ◽

Ischemic Time ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment

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Minimally Invasive Left Ventricular Assist Device Insertion Facilitates Subsequent Heart Transplant

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984520980409 ◽

2021 ◽

pp. 155698452098040

Author(s):

Joseph Rabin ◽

Luke A. Ziegler ◽

Sarah Cipriano ◽

Ronson J. Madathil ◽

Erika D. Feller ◽

...

Keyword(s):

Minimally Invasive ◽

Left Ventricular Assist Device ◽

Heart Transplant ◽

Ventricular Assist Device ◽

Cardiac Transplantation ◽

Left Ventricular ◽

Assist Device ◽

Ventricular Assist ◽

Ischemic Time ◽

Left Ventricular Assist

Objective We have observed that minimally invasive left ventricular assist device (LVAD) insertion leads to more facile re-entry and easier cardiac transplantation. We hypothesize minimally invasive LVAD implantation results in improved outcomes at the time of subsequent heart transplant. Methods All adults undergoing cardiac transplantation between October 2015 and March 2019 at our institution were retrospectively reviewed. Those bridged to transplantation with a HeartWare HVAD were identified and divided into 2 cohorts based upon the surgical approach: those who underwent HVAD placement by conventional sternotomy versus minimally invasive insertion via lateral thoracotomy and hemisternotomy (LTHS). Patient demographics, as well as perioperative transplant outcomes, including survival, length of stay (LOS), blood utilization, ischemic time, bypass time, and postoperative extracorporeal membrane oxygenation (ECMO) were compared between cohorts. Results Forty-two patients were bridged to heart transplant with a HVAD implanted via either sternotomy ( n = 22) or LTHS technique ( n = 20). Demographics were similar between groups. There was 1 predischarge death in the sternotomy group and none in the LTHS group. Body surface area, cardiopulmonary bypass time, ischemic time, ECMO utilization, and reoperation for bleeding were similar. Red blood cell units transfused were significantly lower in the LTHS cohort (3.0 [1.0-5.0] vs 6.0 [2.5-10.0] P = 0.046). The LTHS cohort had a significantly shorter hospital LOS (12.0 [11.0-28.0] vs 22.5 [15.7-41.7] P = 0.022) with a trend toward shorter intensive care unit LOS (6.0 [5.0-10.5] vs 11.0 [6.0-21.5] days P = 0.057). Conclusions Minimally invasive HVAD implantation improves outcomes at subsequent heart transplantation, resulting in shorter LOS and less red cell transfusion. Larger multi-institutional studies are necessary to validate these findings.

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Reducing Cardiac Injury during ST-Elevation Myocardial Infarction: A Reasoned Approach to a Multitarget Therapeutic Strategy

Journal of Clinical Medicine ◽

10.3390/jcm10132968 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2968

Author(s):

Alessandro Bellis ◽

Giuseppe Di Gioia ◽

Ciro Mauro ◽

Costantino Mancusi ◽

Emanuele Barbato ◽

...

Keyword(s):

Myocardial Infarction ◽

Reperfusion Injury ◽

Therapeutic Strategy ◽

Ventricular Remodeling ◽

Ischemia Reperfusion Injury ◽

Ischemia Reperfusion ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Ischemic Time ◽

St Elevation

The significant reduction in ‘ischemic time’ through capillary diffusion of primary percutaneous intervention (pPCI) has rendered myocardial-ischemia reperfusion injury (MIRI) prevention a major issue in order to improve the prognosis of ST elevation myocardial infarction (STEMI) patients. In fact, while the ischemic damage increases with the severity and the duration of blood flow reduction, reperfusion injury reaches its maximum with a moderate amount of ischemic injury. MIRI leads to the development of post-STEMI left ventricular remodeling (post-STEMI LVR), thereby increasing the risk of arrhythmias and heart failure. Single pharmacological and mechanical interventions have shown some benefits, but have not satisfactorily reduced mortality. Therefore, a multitarget therapeutic strategy is needed, but no univocal indications have come from the clinical trials performed so far. On the basis of the results of the consistent clinical studies analyzed in this review, we try to design a randomized clinical trial aimed at evaluating the effects of a reasoned multitarget therapeutic strategy on the prevention of post-STEMI LVR. In fact, we believe that the correct timing of pharmacological and mechanical intervention application, according to their specific ability to interfere with survival pathways, may significantly reduce the incidence of post-STEMI LVR and thus improve patient prognosis.

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P5264There is no significant effect of ischemic time and elapse time since cardiac allograft transplant on myocardial T1 relaxation time

European Heart Journal ◽

10.1093/eurheartj/ehz746.0235 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Vietheer ◽

C Unbehaun ◽

K Classen ◽

M Richter ◽

A Rieth ◽

...

Keyword(s):

Allograft Rejection ◽

T1 Mapping ◽

Cardiac Allograft ◽

Elapse Time ◽

Ischemic Time ◽

Elapsed Time ◽

Native T1 ◽

Transplant Patients ◽

T1 Relaxation ◽

Stress Cmr

Abstract Background Graft failure caused by allograft rejection and vasculopathy is the most common cause of mortality after heart transplantation. To detect an early allograft rejection, endomyocardial biopsy is still needed. Tissue characterization by T1-mapping and Late gadolinium enhancement is well established in acute and chronic myocardial tissue alterations. Therefore several studies investigated T1-mapping as a potential noninvasive parameter to monitor cardiac allograft vasculopathy and allograft rejection. However it is unclear if T1 is also influenced by pretransplant ischemic time and elapsed time since transplantation. Purpose It was the aim of our study to examine the influence of ischemic and elapsed time since transplantation to the cardiac allograft tissue characteristics measured by CMR T1 relaxation times. Methods Allograft transplant patients underwent stress CMR on a yearly routine. T1-maps were acquired using a modified look locker sequence (MOLLI 3(2)3(2)5) in the midventricular septum. Uni- and multi linear regression analysis was used to predict T1 by ischemic time, time since transplantation, troponin and NT-Pro-BNP. Results 49 cardiac allograft transplanted patients underwent stress CMR (mean age 58.6±11.7 years, left ventricular ejection fraction 62.1±6.8%; indexed enddiastolic volume 68.4±14.7 ml/m2; native T1 1120±51 ms, extracellular volume 0.27±0.04). A significant correlation was found between T1 and NT-Pro-BNP (1519±3639 pg/ml, p=0.003) and a trend for troponin (17.0±12.8 ng/dl, p=0.051). We saw no correlation between T1 and the ischemic time (198.4±44.9 minutes, p=0.1172) and elapse time since transplantation (47±7 month, p=0.9868). In the multivariate regression analysis none of the four parameters were independently associated with the T1 time (p=0.1017). Table 1 Characteristics Mean ± SD p Ischemic time (minutes) 198.4±44.9 0.1172 Time since transplant (month) 47±7 0.9868 NT-Pro-BNP (pg/ml) 1519±3639 0.003 Troponine (ng/dl) 17.0±12.8 0.051 Conclusion There was no significant effect of pretransplant ischemic time and elapse time since transplantation on native T1 times, whereas native T1 was significantly correlated with troponine and NT-Pro-BNP-Levels. T1 is excellently suited to detect acute changes in allograft transplant patients without being influenced by aging of the transplanted heart and the heart's pretransplant condition.

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