Using self -suture branching artificial vesssels in aortic arch surgery at Hanoi Heart Hospital

Background: For aortic arch surgery, the improvement of anastomosis technique, and the improvement of using self-suture branching artificial vessels have shortened the time and reduced the cost of surgery. The study aimed to evaluate the improved results of using self-suture branched artificial vessels in aortic arch surgery. Methods: A retrospective descriptive study of the use of self-suture branching artificial vessels in aortic arch surgery at Hanoi Heart Hospital from October 2018 to May 2021. Results: There were 33 cases of aortic arch replacement using self-suture branching artificial vessels. The rate of postoperative bleeding was 6.06%. The rate of artificial vessel infection is 0%. Conclusion: Using self-suture branching artificial vessels in aortic arch surgery is a safe and effective technique.

Early outcome of surgical treatment of 20 cases of postinfartion ventricular septal rupture by extended sandwich patch technique via right ventricle approach

Objective: Different techniques have been described to repair post myocardial infarction ventricular septal rupture (VSR), each method may result in residual shunting, bleeding, and post-operative mortality. The aim of this report is to describe early results of extended sandwich technique through right ventricle in 20 consecutive patients. Patients and Methods: A retrospective, cross-sectional and descriptive study on 20 patients underwent surgery for myocardial infarction VSR by extended sandwich technique through right ventricle from 12/2018 to 3/2021 in Hanoi Heart Hospital. Result: 20 consecutive patients (10 women and 10 men) with postinfarction ventricular septal rupture (mean age 72 years, range 48-84) underwent surgical repair for by extended sandwich technique performed through right ventricle from December 2018 to August 2021 in our institute. Reconstruction of the septum was performed by two patches according to the method described by Asai et al. The mean aortic clamp time was 101. The mean extracorporeal circulation time was 143 min. Postoperative intensive care unit (ICU) stay averaged 4 days (range, 1-10 days). There was 30% hospital mortality. 10% postoperative residual shunting was detected, and no patient needed reoperation for bleeding. Conclusion: This method of extended sandwich technique through right ventricle was safe, simple, and it could be performed in acute phase of myocardial infarction.

Outcomes of surgical treatment of Stanford type of aortic dissection at Hanoi Heart Hospital in the period 2015-2020

Background: Stanford type A aortic dissection is a complex disease and a serious surgical emergency. The diagnosis is determined based on diagnostic imagines. Surgery is the mainstay of treatment, with high mortality and morbidity. This study aimed to comment on clinical and paraclinical characteristics and evaluate the results of surgical treatment of type A aortic dissection at Hanoi Heart Hospital within 5 years from 2015 to 2020. Methods: Retrospective and descriptive study of patients diagnosed with type A aortic dissection who were surgically treated at Hanoi Heart Hospital from January 2015 to May 2020. Results: 109 cases were included in the study with the mean age of 56.0 ± 14.4; 50 - 60 age accounted for the highest percentage (30.3%); men accounted for 67.9%. Classic type A aortic dissection in 95 cases (87.2%). Chest pain was the main clinical symptom (91.7%); 4.6% came to the hospital in a state of cardiogenic shock and circulatory arrest. The rate of Marfan phenotype was 13.8%. The most common surgery is replacing the ascending aorta (45.9%); total replacement of the aortic arch accounted for 17.4%; Total root replacement and aortic arch accounted for 3.7%. The average aortic pairing time was 120.7 ± 41.0 minutes, the mean running time was 179.7 ± 57.0 minutes. Re-operative bleeding accounted for 6,4%; cerebrovascular accident accounted for 2,8%. The early mortality rate after surgery was 9.2%. The mean follow-up time was 24.93 ± 16.13 months, the mean survival time was 52.0 ± 1.9 months, the survival rate was 88.1% after 1 year and 85.3% after 5 years. Conclusion: Early mortality, postoperative complications and survival rate after follow-up were positive with surgical technique and conditions of anesthesia and resuscitation at Hanoi Heart Hospital.

Clinical and laboratory testing of oral anticoagulation therapy vitamin k antagonists at the emergency department of Hanoi Heart Hospital

Background: The most commonly used oral anticoagulant is acenocoumarol with the brand name is Sintrom and recently, warfarin with the brand name is Coumadin has begun to be used. Anticoagulation with vitamin K antagonists faces two main obstacles: the narrow therapeutic range and the effectiveness of the drug varies by many factors. Objective: " Current status of coagulation disorders in the treatment of anticoagulants with vitamin K antagonists. Understanding some factors affecting the goal of anticoagulant treatment". Method: Cross-sectional, retrospective, descriptive analysis of drug use and influencing factors of patients diagnosed with coagulopathy admitted to the emergency department at Hanoi Heart Hospital from April 2020 to August 2021. Results: There were 675 patients admitted to the hospital with blood clotting disorders. The average age is 60,17±10,13, the youngest is 30, the oldest is 90; 63 patients, accounting for 9.42%, need to be hospitalized for inpatient treatment; There are 108 patients, accounting for 16%, with bleeding and 18 patients, accounting for 2.7%, with thromboembolism or valve obstruction. Conclusion: Coagulation disorders during treatment with vitamin K antagonist anticoagulants is a common condition in the emergency department. However, the complication rate is not high. There are many factors that affect the patient's treatment goals and the drug use is a fairly common factor.

Short – term outcomes of flow diverter stent (Pipeline) for treatment intracranial aneurysms

Background: With the approval of detachable coils in 1995, endovascular treatment of intracranial aneurysms has become an alternative to surgical clip ligation. Despite the introduction of “modified” coils and advanced techniques such as stent-assisted and balloon-assisted coiling, coil embolization has major limitations because of inability to completely and permanently occlude all aneurysms. As stents were being developed for intracranial use, it was hypothesized that stents could be utilized to divert flow “away” from the aneurysm “back” into the parent vessel, and the concept of “endovascular flow diversion” was proposed. This study aims to report our experience with cerebral aneurysms, which may improve in the treatment with the flow-diverter stent and follow up (1). Methods: This study was conducted in consecutive series of 23 patients. 23 procedures were performed for treating these patients in Ha Noi heart hospital from January 2019 to January 2020. 23 flow diverter stents (Pipeline) were used. Aneurysms morphology, stent patency and cerebral parenchyma before and after intervention were analyzed on images of digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR). The follow-up data after 3–6 months and 12 months were recorded. Results: In 23 patients (8 men, 15 women), aneurysms of internal carotid artery were mostly common (95.7%), especially in cavernous segments. 13 cases (74%) had saccular aneurysms, and 2 cases (9%) had multiple aneurysms, and only 3 cases (13%) had fusiform aneurysms. Endovascular treatment was successfully performed at rate of 100%.. Mortality and morbidity rates were 0% and 0%, respectively. MRI and MSCT follow-up at 3 months showed complete or incomplete occlusions of aneurysms was 26.1% or 34.8%, respectively. Conclusions: Deployment of flow diverter stent is safe and effective with high rate of successful and low procedural complications

Surgical treatment of left-sided infective endocarditis in Hanoi Heart Hospital

Objective: to evaluate the short-term outcomes of surgical treatment of left-sided infective endocarditis (IE) in Hanoi Heart Hospital. Patients and Methods: A retrospective, cross-sectional and descriptive study on all patients underwent surgery for left-sided IE from 3/2015 to 3/2019 in Hanoi Heart Hospital. Result: 56 patients underwent surgery for left-sided IE in 4 years; the mean age was 45.8 ± 16.0; male-female ratio was 3.3/1. 9 patients (16.1%) had prosthetic valve endocarditis. Preopeative blood cultures were positive in 35.7%, the mainly microorganism was Streptococcus (21.4%). Emergency and urgent surgery was performed in 14.3%; the most frequently postoperative complication was kidney failure, the in-hospital mortality rate was 5.4%. During the average follow-up time of 36.6± 14.2 months, the recurrence rate of IE was 17.8%. Conclusion: surgical treatment of left-sided infective endocarditis is still a great challenge, the early recurrence and motality rate are high.

Short-term outcomes of endovascular therapy for chronic lower extremity arterial disease

Background: Chronic lower extremity arterial disease, mostly caused by atherosclerotic etiology, has been increasing in recent years. Currently, there has been a shift in the treatment chronic lower extremity arterial disease from open surgical treatment to endovascular intervention. According to the TASC classification, surgical treatment is preferred for patients with complex lesions of TASC C, D but recent studies have shown that endovascular intervention has had good results for high-grade lesions. Objective: To determine the efficacy, short-term results of endovascular intervention in patients with symptomatic lower extremity artery disease Methods: From January to December 2021, the cross sectional, descriptive study was carried out on 38 patients with lower limb artery disease, treated by endovascular intervetion in Interventional Department, Hanoi Heart hospital. All patients were evaluated by clinical symptoms, ankle- brachial index and lesion characteristic before and after the intervention to determine the initial success Results: Majority of lesions belong to TASC II C and D (78,9%). Injured arteries can be isolated in the aortoiliac (21,1%), femoropopliteal (21,1%), below-knee artery (21,1%) or combine aortoiliac and femoropopliteal (10,5%), femoropopliteal and BTK (15,8%). The ankle- brachial index before and after the intervention respectively 0,57 and 0.83 (p<0,001). The technical successful rate was 94,7%. Balloon angioplasty and stent placement were in 21 patients (55,3%) and balloon angioplasty in 17 patients (44,7%). Post-procedural complications included stent thrombosis (2.6%), amputation (2.6%), pseudoaneurysm at the puncture site (2.6%). Conclusion: Endovascular intervention is a safe, effective, minimally invasive method in the treatment of chronic lower extremity arterial disease

Study on the characteristics of coronary calcification by Intravascular Ultrasound (IVUS)

Background: Percutaneous coronary angiography is considered the "gold standard" for the diagnosis of coronary artery disease and provides the necessary anatomical information to provide appropriate treatment. The limitation of coronary angiography is the accurate assessment of calcified coronary lesions. Intravascular ultrasonography has many advantages in the assessment of calcified coronary lesions. Methods: The descriptive clinical study. Evaluation of calcified coronary artery lesions by intravascular ultrasound Results: From January 2019 to December 2019, at the Hanoi Heart Institute, 64 patients had 64 coronary artery lesions surveyed by intravascular ultrasound. There were 42 (65,6%) calcified lesions assessed by IVUS and 25 (39,1%) calcified lesions were detected by coronary angiography. In addition, the location of calcified were revealed more in the LAD compared to other: LAD 60%, LCx 24%, RCA 12% and LM 4%. Conclusion: IVUS calcification detection rate is higher than coronary angiography. The most common site of calcification in the LAD.

Clinical characteristics, laboratory findings and anatomy of intracranial aneurysms in group of patients treated with flow diverter stent (Pipeline)

Background: This study aim to report our experience with cerebral aneurysm, which may improve in the treatment with the flow diverter stent and follow up. Methods: This study was conducted in consecutive series of 23 patients. 23 procedures were performed for treating these patients in Ha Noi heart hospital from January 2019 to January 2020. 23 flow diverter stents (Pipeline) were used. Aneurysm morphology, stent patency and cerebral parenchyma before and after intervention were analyzed on images of digital subtraction angiography (DSA), computed tomography (CT) and magnetic resonance (MR). The follow-up data after 3–6 months and 12 months were recorded. Results: In 23 patients (8 men, 15 women), aneurysms of internal carotid artery were mostly common (95.7%), especially in cavernous segments. 13 cases (74%) had saccular aneurysms, and 2 cases (9%) had multiple aneurysms, and only 3 cases (13%) had fusiform aneurysms. Endovascular treatment was successfully performed at rate of 100%. Mortality and morbidity rates were 0% and 0%, respectively. MRI and MSCT follow-up at 3 months showed complete or incomplete occlusions of aneurysms was 26.1% or 34.8%, respectively. Conclusion: Unruptured intracranial aneurysms are often detected incidentally on screening imaging in high risk patients, such as women, middle age, estrogen deficiency, and hypertension. The aneurysm is usually small in the cavernous segment of the anterior cerebral artery.

Evaluate the results of veno-arterial extracorporeal membrane oxygenation for cardiogenic shock patient

Background: Although there are many advances in the diagnosis and resuscitation of patients with cardiogenic shock, the mortality rate is still high, especially for patients with cardiogenic shock due to complications of acute myocardial infarction, the mortality rate can be up to 50 - 70%. Objective: "Evaluate the effectiveness of clinical, subclinical and complications of V-A ECMO in patients with cardiogenic shock". Method: Retrospective analysis of patients diagnosed with cardiogenic shock supported by V-A ECMO revascularization from October 2018 and June 2020; Analyze the significance of V-A ECMO with the clinical outcome prognosis and and complications of V-A ECMO. Results: There were 23 patients hospitalized for cardiogenic shock, they have used the V-A ECMO. The mean age was 53,5±17,6, the minimum age was 13, the oldest was 76. The shortest hospital stay time was 3.5 day and the longest treatment time is 32 days. There were 15 patients alive, accounting for 65.2%, 8 patients died, accounting for 35.8%. The percentage of patients living in the group of myocarditis reached the highest rate. Common complications in patients supported by V-A ECMO are left ventricular volume overload and infection. Conclusion: V-A ECMO is a treatment option for life-threatening cardiogenic shock that has not responded to other therapies.