Publications by authors named "Alireza Alizadeh-Ghavidel"

54 Publications

A rare cause of complete heart block in an adult: Primary cardiac lymphoma.

Asian Cardiovasc Thorac Ann 2021 Mar 16:2184923211001697. Epub 2021 Mar 16.

Echocardiography Research Center, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Primary cardiac lymphoma (PCL) is a rare primary cardiac neoplasm with a relatively poor prognosis despite confinement to the heart and/or pericardium. We report a 54-year-old man who had presented with complete heart block for which he had undergone permanent pacemaker implantation, and six months later he was referred to us for evaluation of progressive exertional dyspnea. Multislice spiral computed tomography angiography of the heart and major vasculature showed infiltrative tumoral lesion that has involved interatrial septum, right atrium, left atrium, and left ventricle with invasion into the pulmonary artery. Tissue samples were taken using uniportal video-assisted thoracoscopic surgery, and the histologic examination revealed diffuse large B-cell lymphoma. Chemoimmunotherapy was effective in inducing tumor regression and the patient was still in remission during the next six months after treatment.
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http://dx.doi.org/10.1177/02184923211001697DOI Listing
March 2021

Comparison of Normal Saline, Ringer's and Ringer's lactate as Z-BUF fluids in management of perioperative serum Sodium and Potassium levels.

Artif Organs 2021 Mar 9. Epub 2021 Mar 9.

Cardiovascular, Medical and research Center, perfusion, Tehran, Iran.

Background: Zero-balance ultrafiltration (Z-BUF) is considered a significant method during cardiopulmonary bypass (CPB), and has always received support regarding its key role in monitoring electrolyte abnormalities including potassium and sodium derangements and managing them which occur commonly during CPB. With Z-BUF procedure's impact on controlling electrolyte abnormalities, we conducted a study in order to find out the most efficient solution regarding managing potassium and sodium levels to be selected as replacement fluid in Z-BUF out of the three commonly used normal saline, ringer's and ringer's lactate.

Method: a randomized clinical trial study was conducted and 90 patients were divided into three groups. Each group was given a certain solution out of the three normal saline (Z-BUF-NS), ringer's (Z-BUF-R), and ringer's lactate (Z-BUF-RL) with allocation concealment strategy then potassium and sodium levels were measured at 5 points of the whole procedure: prior to CPB and after anesthesia induction, cardioplegic solution's delivery, pre-Z-BUF, post-Z-BUFF, and at the end of CPB.

Results: Comparing pre-Z-BUF and post-CPB patients' serum potassium demonstrated a change from 4.7 0.9 mEq/L to 5.2 0.7 mEq/L in Z-BUF-RL, 4.4 0.6 mEq/L to 4.7 0.5mEq/L in Z-BUF-R, and 5.1 0.5 mEq/L to 5.1 0.5 mEq/L in Z-BUF-NS. No significant difference was observed between groups regarding managing K+ abnormalities. Changes in Na+ from pre-Z-BUF to post-CPB were as following: from 134 mEq/L to 133 mEq/L in Z-BUF-RL, 137 mEq/L to 137 mEq/L in Z-BUF-R, and 135.2 4 mEq/L to 136.5 4 mEq/L in Z-BUF-NS. Ringer's lactate managed sodium abnormalities more efficiently.

Conclusion: Ringer's lactate is more efficient than Ringer's and normal saline regarding managing sodium and potassium abnormalities.
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http://dx.doi.org/10.1111/aor.13950DOI Listing
March 2021

Effects of intravenous and transdermal photobiomodulation on the postoperative complications of coronary artery bypass grafting surgery: a randomized, controlled clinical trial.

Lasers Med Sci 2021 Jan 4. Epub 2021 Jan 4.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Although coronary artery bypass graft (CABG) surgery is one of the most worldwide commonly performed cardiac surgeries to enhance myocardial perfusion in high-grade myocardial occlusion, it remains a high-risk procedure. Photobiomodulation (PBM) is one of the methods which have been shown to have positive effects on the healing process after CABG and postoperative complications. The aim of this study was to evaluate the efficacy of PBM in patients who underwent a coronary artery bypass graft (CABG). Ths study was conducted with 192 volunteers who electively submitted to CABG. The volunteers were randomly allocated into two groups: laser-treated (transdermal: 980 nm, 200 mW, continuous, average energy fluency of 6 J/cm and intravenous: 405 nm, 1.5 mW, continuous for 30 min) and standard treatment and control group (standard treatment only). Intravenous laser was illuminated the day before the surgery, immediately after transferring the patient to CCU post-operation and IV laser in addition to transdermal laser was applied every day after surgery for 6 days. A total of 170 out of 192 participants completed the study, 82 (48.2%) in the PBM group and 88 (51.8%) in the control group. Level of LDH and CPK was significantly lower in the PBM group (P < 0.05) in the 4th day postoperatively. The PBM group also showed significantly lower post-surgery complications, including pericardial effusion, ejection fraction, pathologic ST changes, pathologic Q, rehospitalization, heart failure, and mediastinitis (P < 0.05). Likewise, the VAS pain score after surgery was significantly lower in patients in the laser group (P < 0.05). PBM seems a promising, safe, cost-benefit therapeutic modality to reduce postoperative complications of CABG. Trial registration number: IRCT2016052926069N4 .
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http://dx.doi.org/10.1007/s10103-020-03236-3DOI Listing
January 2021

Large pericardial mesothelial cyst coexisting with hypertrophic obstructive cardiomyopathy.

ARYA Atheroscler 2020 Mar;16(2):102-104

Fellowship, Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Pericardial mesothelioma cyst occurs rarely, and is often found incidentally. The coexistence between large pericardial mesothelial cyst and hypertrophic obstructive cardiomyopathy (HOCM) can make difficulties in medical management.

Case Report: Our case was a 33-year-old man presented with dizziness and pallor while standing since four years before, and recent syncope. On admission, transthoracic echocardiography reveled presence of hypertrophic cardiomyopathy in association with relatively small right ventricular and atrium due to compression effect by a large echo-free space at the right side of heart suggestive of pericardial cyst. Cardiac computed tomography confirmed presence of HOCM and large pericardial cyst. Patient underwent surgical septal myectomy and large mesothelial pericardial cyst excision because of persistent symptoms and compression effect of cyst on the right chambers despite beta-blocker therapy.

Conclusion: To best of our knowledge, the coexistence of the large pericardial mesothelial cyst and HOCM has not been reported before.
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http://dx.doi.org/10.22122/arya.v16i2.2014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578523PMC
March 2020

Iranian Society of Cardiac Surgeons COVID-19 task force version II, restarting elective surgeries.

J Cardiovasc Thorac Res 2020 22;12(3):158-164. Epub 2020 Jul 22.

Department of Social Medicine, Rajaei Cardiovascular Medical & Research Center, Iran University of Medical Science, Tehran Iran.

Given the nature of heart disease and the importance of continuing heart surgery during the pandemic and its aftermath and in order to provide adequate safety for the surgical team and achieve the desired result for patients, as well as the optimal use of ICU beds, the medical team, blood, blood products, and personal protective equipment, it is essential to change the usual approach during the pandemic. There are still a lot of evidences and experiences needed to produce the perfect protocol. Some centers may have a special program for their centers during this period of epidemics that can be respected and performed. Generally, in pandemic conditions, the use of non-surgical approaches is preferred if similar outcomes can be obtained.
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http://dx.doi.org/10.34172/jcvtr.2020.28DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7581843PMC
July 2020

Challenges and experience of setting up an aortic service.

Asian Cardiovasc Thorac Ann 2020 May 29:218492320930841. Epub 2020 May 29.

Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Aortic surgery is a complex procedure posing high risks in comparison to other adult cardiac surgeries. Novel surgical approaches including minimally invasive procedures, sutureless aortic valve replacement, and transcatheter aortic valve implantation have been found to be acceptable alternatives to conventional surgeries. In addition, novel endovascular repair techniques and hybrid procedures have been introduced for the management of patients with thoracoabdominal aortic pathologies. However, these modalities are not readily available in every center, and such novel procedures impose a learning curve for surgeons and high costs for affected patients. In this review, we discuss the challenges of setting up an aortic service, having regard to the Iranian experience.
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http://dx.doi.org/10.1177/0218492320930841DOI Listing
May 2020

Extremely rare and giant cavernous cardiac hemangioma.

Turk Gogus Kalp Damar Cerrahisi Derg 2020 Jan 23;28(1):213-214. Epub 2020 Jan 23.

Department of Pathology, Rajaie Cardiovascular, Medical and Research Center, Tehran, Iran.

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http://dx.doi.org/10.5606/tgkdc.dergisi.2020.18902DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067030PMC
January 2020

Concomitant cardiac and hepatic hemangiomas.

Echocardiography 2020 03 12;37(3):462-464. Epub 2020 Feb 12.

Rajaei Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Primary tumors of the heart are rare with a reported incidence of about 0.002% to 0.3% at autopsy. A cardiac hemangioma is a form of benign primary cardiac tumor that often presents with atypical clinical symptoms. Hemangiomas are generally isolated lesions. Here, we report a patient with previous hepatic hemangioma who later was found to have a large coexistent cardiac hemangioma presenting with cardiac compressive symptoms.
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http://dx.doi.org/10.1111/echo.14614DOI Listing
March 2020

Comparison of standard coagulation testing with thromboelastometry tests in cardiac surgery.

J Cardiovasc Thorac Res 2019 13;11(4):300-304. Epub 2019 Oct 13.

Departments of Immunology, Faculty of Medicine, Tarbiat Modares University of Medical Sciences, Tehran, Iran.

According to the several evidences, using thromboelastometry as a point of care test can be effective in reduction in blood loss and transfusion requirements in cardiac surgeries. However, there are limited data regarding to the comparison of thromboelastometry and the standard coagulation tests. In this study, we compared thromboelastometry and standard coagulation tests (PT, PTT and fibrinogen level) in patients under combined coronary-valve surgery. Forty adult patients who were under on-pump combined coronary-valve surgery were included in this study. Thromboelastometry tests Fibtem, Intem, Extem and Heptem), along with standard coagulation tests (PT, PTT and fibrinogen assay) were simultaneously performed in two time points, before and after the pump (pre-CPB and post-CPB, respectively). A total of 80 blood samples were analyzed. There were no significant correlation between PT test and the CT-Extem parameter as well as PTT and CT-Intem parameter either in pre-CPB and post-CPB ( >0.05). On the contrary, fibrinogen level had high correlation with A10-Fibtem and A10-Extem in pre-PCB ( <0.05). 82% of PT and 84% of PTT measurements were outside the reference range, while abnormal CT in Extem and Intem was observed in 17.9%. For management of bleeding, adequate perioperative haemostatic monitoring is indispensable during cardiac surgery. Standard coagulation tests are time consuming and cannot be interchangeably used with thromboelastomety and relying on their results to decide whether blood transfusion is necessary, leads to the inappropriate transfusion.
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http://dx.doi.org/10.15171/jcvtr.2019.48DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6891038PMC
October 2019

Postoperative Atrial Fibrillation Following Cardiac Surgery: From Pathogenesis to Potential Therapies.

Am J Cardiovasc Drugs 2020 Feb;20(1):19-49

Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Vali-e-Asr Avenue, Tehran, 1995614331, Iran.

Postoperative atrial fibrillation (POAF) is a major complication after cardiac surgery which can lead to high rates of morbidity and mortality, an enhanced length of hospital stay, and an increased cost of care. POAF is postulated to be a multifactorial phenomenon; however, some major pathogeneses have been proposed, including inflammatory pathways, oxidative stress, and autonomic dysfunction. Genetic studies also showed that inflammatory pathways, beta-1 adrenoreceptor variants, G protein-coupled receptor kinase 5 gene variants, and non-coding single-nucleotide polymorphisms in the 4q25 chromosomal locus are involved in this phenomenon. Moreover, several predisposing factors lead to the development of POAF, consisting of pre-, intra-, and postoperative contributors. The main predisposing factors comprise age, prior history of major cardiovascular risk factors, and ischemia-reperfusion injury during surgery. The management of POAF is based on the usual therapies used for non-surgical AF, including medications for either rate control or rhythm control in hemodynamically unstable patients. The perioperative administration of β-blockers and some antiarrhythmic agents has been recommended in major international guidelines. In addition, upstream therapies consisting of colchicine, magnesium, statins, and antioxidants have attenuated the incidence of POAF; however, some uncomfortable side effects developed in large randomized trials. The use of anticoagulation has also resulted in less mortality in patients with POAF at higher risk of thromboembolic events. Despite these recommendations, the actual regimen for the prevention of POAF remains controversial. In this review, we highlight the pathogenesis, predisposing factors, and potential therapeutic options for the management of patients at risk for or with POAF following cardiac surgery.
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http://dx.doi.org/10.1007/s40256-019-00365-1DOI Listing
February 2020

Cardiac hydatid cyst: A rare presentation of echinococcal infection.

J Cardiovasc Thorac Res 2019 13;11(1):75-77. Epub 2019 Mar 13.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

A 57-year-old man presented with atypical chest pain. Transthoracic echocardiography was performed and revealed a very large and well defined intra-myocardial multicystic mass in the posterolateral and basal inferoseptal segments of left ventricle suggestive of hydatid cyst. Although the echocardiographic diagnosis was straightforward, serologic test (hydatid cyst antibody) with enzyme-linked immunosorbent assay (ELISA) was performed which was positive for echinococcal infection. Other works up showed no involvement of other organ system. Albendazol was started for him and he referred to cardiac surgeon for resection of cystic mass.
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http://dx.doi.org/10.15171/jcvtr.2019.13DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477106PMC
March 2019

Mesenchymal stem cells from human amniotic membrane differentiate into cardiomyocytes and endothelial-like cells without improving cardiac function after surgical administration in rat model of chronic heart failure.

J Cardiovasc Thorac Res 2019 25;11(1):35-42. Epub 2019 Feb 25.

Department of Physiology and Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Human amnion-derived mesenchymal stem cells (hAMSCs) have been used in the treatment of acute myocardial infarction. In the current study, we investigated the efficacy of hAMSCs for the treatment of chronic model of myocardial ischemia and heart failure (HF) in rats. Male Wistar rats weighing between 250 to 350 g were randomized into three groups: sham, HF control and HF+hAMSCs. For HF induction, animals were anesthetized and underwent left anterior descending artery ligation. In HF+hAMSCs group, 2×106 cells were injected into the left ventricular muscle four weeks post ischemia in the border zone of the ischemic area. Cardiac function was studied using echocardiography. Masson's trichrome staining was used for studying tissue fibrosis. Cells were transduced with green fluorescent protein (GFP) coding lentiviral vector. Immunohistochemistry was used for detecting GFP, vascular-endothelial growth factor (VEGF) and troponin T markers in the tissue sections. Assessment of the cardiac function revealed no improvement in the myocardial function compared to the control HF group. Moreover, tissue fibrosis was similar in two groups. Immunohistochemical study revealed the homing of the injected hAMSCs to the myocardium. Cells were stained positive for VEGF and troponin T markers. injection of hAMSCs 4 weeks after ischemia does not improve cardiac function and cardiac muscle fibrosis, although the cells show markers of differentiation into vascular endothelial cells and cardiomyocytes. In sum, it appears that hAMSCs are effective in the early phases of myocardial ischemia and does not offer a significant advantage in patients with chronic HF.
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http://dx.doi.org/10.15171/jcvtr.2019.06DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6477105PMC
February 2019

Feasibility of On-table Extubation After Cardiac Surgery with Cardiopulmonary Bypass: A Randomized Clinical Trial.

Anesth Pain Med 2018 Oct 24;8(5):e80158. Epub 2018 Sep 24.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: The use of short-acting anesthetics, muscle relaxation, and anesthesia depth monitoring allows maintaining sufficient anesthesia depth, fast recovery, and extubation of the patients in the operating room (OR). We evaluated the feasibility of extubation in the OR in cardiac surgery.

Methods: This clinical trial was performed on 100 adult patients who underwent elective noncomplex cardiac surgery using cardiopulmonary bypass. Additional to the routine monitoring, the patients' depth of anesthesia and neuromuscular blocked were assessed by bispectral index and nerve stimulator, respectively. In the on-table extubation (OTE) group (n = 50), a limited dose of sufentanil (0.15 µg/kg/h) and inhalational anesthetics were used for early waking. In the control group (n = 50), the same anesthesia-inducing drugs were used but the dose of sufentanil during the operation was 0.7 - 0.8 µg/kg/h. After the operation, cardiorespiratory parameters and ICU stay were documented.

Results: Demographic and clinical variables were comparable in both study groups. In the OTE group, we failed to extubate two patients in the OR (success rate of 96%). There were no significant differences between the two groups in terms of systolic and diastolic blood pressure at the time of entering the ICU (P > 0.05). Heart rate was lower in the OTE than in the control group at ICU admission (89.4 ± 13.1 vs. 97.6 ± 12.0 bpm; P = 0.008). The ICU stay time was lower in the OTE group (34 (21.5 - 44) vs. 48 (44 - 60) h; P = 0.001).

Conclusions: Combined inhalational-intravenous anesthesia along with using multiple anesthesia monitoring systems allows reducing the dose of total anesthetics and maintaining adequate anesthesia depth during noncomplex cardiac surgery with cardiopulmonary bypass. Thus, extubation of the trachea in the OR is feasible in these patients.
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http://dx.doi.org/10.5812/aapm.80158DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6240920PMC
October 2018

A comprehensive multimodality heart motion prediction algorithm for robotic-assisted beating heart surgery.

Int J Med Robot 2019 Apr 19;15(2):e1975. Epub 2018 Dec 19.

Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: An essential requirement for performing robotic-assisted surgery on a freely beating heart is a prediction algorithm that can estimate the future heart trajectory.

Method: Heart motion, respiratory volume (RV) and electrocardiogram (ECG) signal were measured from two dogs during thoracotomy surgery. A comprehensive multimodality prediction algorithm was developed based on the multivariate autoregressive model to incorporate the heart trajectory and cardiorespiratory data with multiple inherent measurement rates explicitly.

Results: Experimental results indicated strong relationships between the dominant frequencies of heart motion with RV and ECG. The prediction algorithm revealed a high steady state accuracy, with the root mean square (RMS) errors in the range of 82 to 162 μm for a 300-second interval, less than half of that of the best competitor.

Conclusion: The proposed multimodality prediction algorithm is promising for practical use in robotic assisted beating heart surgery, considering its capability of providing highly accurate predictions in long horizons.
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http://dx.doi.org/10.1002/rcs.1975DOI Listing
April 2019

A Hybrid Algorithm for Prediction of Varying Heart Rate Motion in Computer-Assisted Beating Heart Surgery.

J Med Syst 2018 Sep 14;42(10):200. Epub 2018 Sep 14.

Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

An essential requirement for performing robotic assisted surgery on a freely beating heart is a prediction algorithm which can estimate the future trajectory of the heart in the varying heart rate (HR) conditions of real surgery with a high accuracy. In this study, a hybrid amplitude modulation- (AM) and autoregressive- (AR) based algorithm was developed to enable estimating the global and local oscillations of the beating heart, raised from its major and minor physiological activities. The AM model was equipped with an estimator of the heartbeat frequency to compensate for the HR variations. The RMS of the prediction errors of the hybrid algorithm was in the range of 165-361 μm for the varying HR motion, 21% less than that of the single AM model. With the capability of providing highly accurate predictions in a wide range of HR variation, the hybrid model is promising for practical use in robotic assisted beating heart surgery.
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http://dx.doi.org/10.1007/s10916-018-1059-6DOI Listing
September 2018

Congenital Aortico-Left Ventricular Tunnel: A Case Report of a Rare Cause of Aortic Regurgitation in Adults.

J Tehran Heart Cent 2017 Oct;12(4):167-170

Department of Cardiology, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.

The aortico-left ventricular tunnel is a rare congenital abnormality resulting in a pathologic connection between the aorta and the left ventricle. It often presents during infancy or early childhood as a cardiac failure symptom or an incidental finding of a cardiac murmur due to severe aortic regurgitation. It is, however, also occasionally found in asymptomatic adults. We describe a 20-year-old female presenting with palpitations in whom clinical evaluations with echocardiography and computed tomography angiography led to the diagnosis of severe aortic regurgitation caused by a tunnel connecting the right sinus of the aorta to the left ventricle. The patient underwent successful obstruction of the tunnel with an autologous pericardial patch and the repair of the dilated aortic root via the reduction aortoplasty technique. She was discharged on the 5th postoperative day with no complications. At 1 month's follow-up, she remained asymptomatic and echocardiography showed aortic valve competence with no residual regurgitation.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5849589PMC
October 2017

Perioperative changes in platelet count and function in patients undergoing cardiac surgery.

Med J Islam Repub Iran 2017;31:37. Epub 2017 Jul 10.

Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran.

Patients undergoing cardiac surgery are at increased risk of bleeding due to multifactorial coagulopathies. In the present study, we aimed at investigating the changes in platelet count and function during and after surgery as well as determining the association of the platelet dysfunction with bleeding and transfusion requirements in these patients. A total of 40 adult patients scheduled for elective valve coronary cardiac surgery were included in this prospective observational study. Changes in platelet count and function with ADP, acid arachidonic, and collagen (light transmission aggregometry) were analyzed at three time points: before CPB, after CPB, and 24 hours after end of surgery. Postoperative bleeding and intraoperative transfusion requirements were recorded. There were a significant reverse correlation between CPB time and ADP-induced aggregation, particularly after CPB and postoperative AA-induced aggregation. There was not any significant correlation between platelet count and function at all-time points. Both platelet count and platelet aggregation significantly reduced during CPB. While platelet aggregation increased on postoperative Day 1, platelet count reduced by about 40% after CPB, and remained at this level postoperatively. Patients with abnormal ADP-induced aggregation had significant increased postoperative bleeding and transfusion requirements. The results of this study demonstrate that platelet count and platelet aggregation are reduced during CPB. Our results emphasized the effect of platelet dysfunction on increased postoperative bleeding and transfusion requirements. Perioperative monitoring of platelet function can be considered as a bleeding management strategy for implantation of PBM programs.
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http://dx.doi.org/10.14196/mjiri.31.37DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5804419PMC
July 2017

Different Presentation of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery in Adults: Case Reports.

Iran J Med Sci 2017 Nov;42(6):599-602

Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital cardiac malformation. We report three cases of ALCAPA who survived to adulthood. The first case was a 51-year-old woman who complained of typical chest pain that was diagnosed with ALCAPA using cardiac catheterization and coronary computed tomographic angiography (CTA). The second case was a 30-year-old woman with a history of surgery for atrial septal defect at 10 years old who presented with progressive exertional dyspnea. Cardiac catheterization confirmed the diagnosis of ALCAPA. The third case was a 19-year-old man who was brought to our clinic due to aborted sudden cardiac death on the previous day. Cardiac catheterization and coronary CTA confirmed the diagnosis. They underwent the closure of orifice of the anomalous left coronary artery and grafting the left anterior descending artery concomitantly with mitral valve repair. All patients were followed up during a mean of 8.7 months and they were asymptomatic.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5684382PMC
November 2017

Feasibility of infrared tracking of beating heart motion for robotic assisted beating heart surgery.

Int J Med Robot 2018 Feb 23;14(1). Epub 2017 Oct 23.

RCBTR, Tehran University of Medical Sciences, Tehran, Iran.

Background: Accurate tracking of the heart surface motion is a major requirement for robot assisted beating heart surgery.

Method: The feasibility of a stereo infrared tracking system for measuring the free beating heart motion was investigated by experiments on a heart motion simulator, as well as model surgery on a dog.

Results: Simulator experiments revealed a high tracking accuracy (81 μm root mean square error) when the capturing times were synchronized and the tracker pointed at the target from a 100 cm distance. The animal experiment revealed the applicability of the infrared tracker with passive markers in practical heart surgery conditions.

Conclusion: With the current technology, infrared tracking with passive markers might be the optimal solution for accurate, fast, and reliable tracking of heart motion during robot assisted beating heart surgery.
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http://dx.doi.org/10.1002/rcs.1869DOI Listing
February 2018

Mid-term outcomes of surgical repair for anomalous origin of the left coronary artery from the pulmonary artery: In infants, children and adults.

Ann Pediatr Cardiol 2017 May-Aug;10(2):137-143

Department of Pediatric Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Anomalous origin of left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital malformation. We sought to evaluate in-hospital and mid-term outcomes of patients with a diagnosis of ALCAPA who underwent surgical repair.

Objectives: The objective of this study is to evaluate the mid-term outcomes of surgical repair of ALCAPA at our center and to analyze the surgical techniques used.

Materials And Methods: In a retrospective study, we analyzed early and mid-term clinical and echocardiographic data to determine the outcomes of patients who underwent surgical repair of ALCAPA in our institution between 2005 and 2015.

Results: Twenty-one patients underwent surgical repair for ALCAPA using aortic reimplantation ( = 10, 47.6%), ostial closure ( = 8, 38.1%), or ligation ( = 3, 14.3%). The median age of patients was 24 months (range 22 days to 51 years). There were 2 (9.5%) in-hospital mortalities in infants undergoing the reimplantation technique. All patients were followed up for a median of 21 months (range 1-60 months). No patients required reoperation, and there was no mortality from discharge to mid-term follow-up. Severe early postoperative mitral regurgitation (MR) was associated with composite end-point, defined as a combination of mortality after surgery, moderate to severe MR, and moderate to severe left ventricular dysfunction at late follow-up ( = 0.019) while mitral valve repair was not ( = 0.469).

Conclusion: The surgical management of ALCAPA can be associated with good in-hospital and mid-term outcomes regardless of the age, at which the patient has been operated.
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http://dx.doi.org/10.4103/0974-2069.205140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5431025PMC
June 2017

Fish oil supplementation for primary prevention of atrial fibrillation after coronary artery bypass graft surgery: A randomized clinical trial.

Int J Surg 2017 Jun 15;42:41-48. Epub 2017 Apr 15.

Rajaie Cardiovascular Medical & Research Center, Tehran, Iran.

Background: Atrial fibrillation (AF) after cardiac surgery is a common complication that may influence patients' early and long term outcomes and hospital costs. The purpose of this study was to assess the effect of fish oil on occurrence of AF following coronary artery bypass graft surgery (CABG).

Methods: This study was a single-center, randomized, double blinded, placebo-controlled clinical trial. Four-hundred and one patients undergoing coronary artery bypass graft surgery were randomly assigned to receive 2 g/d fish oil or placebo (olive oil) for at least 5 days before surgery. The primary end point was defined as time to AF improvement After AF incidence following isolated CABG or a need for pharmacologic therapy or cardioversion.

Results: The time to AF improvement in intervention group was shorter than control group (HR: 2.05; 95% CI = 0.70-6.22, P = 0.20). The incidence of AF in the intervention and control groups was 8.40% vs. 14.07% respectively (p = 0.07). Mean total duration of AF was 20.96 ± 4.71 h in intervention groups and 46.87 ± 7.44 h in control groups (p = 0.04). Mean duration of stay in the ICU and total hospital stay showed a significant reduction in the intervention group (p = 0.003 and p = 0.04, respectively).

Conclusion: The consumption of PUFA leads to a shorter time to AF improvement, which was not statistically significant. The incidence of AF in patients undergoing CABG surgery was decreased by approximately 5.7%; which was statistically on the borderline. Fish oil reduced median length of stay in the ICU and hospital. Further well-designed studies are needed to overcome the limitations of the existing trials and provide conclusive conclusions.
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http://dx.doi.org/10.1016/j.ijsu.2017.04.025DOI Listing
June 2017

Comparison of current practices of cardiopulmonary perfusion technology in Iran with American Society of Extracorporeal Technology's standards.

J Cardiovasc Thorac Res 2016 28;8(2):72-6. Epub 2016 Jun 28.

Department of Critical Care Nursing, Center for Nursing Care Research, Nursing and Midwifery Faculty, Iran University of Medical Sciences, Tehran, Iran.

Introduction: Standards have a significant role in showing the minimum level of optimal optimum and the expected performance. Since the perfusion technology staffs play an the leading role in providing the quality services to the patients undergoing open heart surgery with cardiopulmonary bypass machine, this study aimed to assess the standards on how Iranian perfusion technology staffs evaluate and manage the patients during the cardiopulmonary bypass process and compare their practice with the recommended standards by American Society of Extracorporeal Technology.

Methods: In this descriptive study, data was collected from 48 Iranian public hospitals and educational health centers through a researcher-created questionnaire. The data collection questionnaire assessed the standards which are recommended by American Society of Extracorporeal Technology.

Results: Findings showed that appropriate measurements were carried out by the perfusion technology staffs to prevent the hemodilution and avoid the blood transfusion and unnecessary blood products, determine the initial dose of heparin based on one of the proposed methods, monitor the anticoagulants based on ACT measurement, and determine the additional doses of heparin during the cardiopulmonary bypass based on ACT or protamine titration. It was done only in 4.2% of hospitals and health centers.

Conclusion: Current practices of cardiopulmonary perfusion technology in Iran are inappropriate based on the standards of American Society of Cardiovascular Perfusion. This represents the necessity of authorities' attention to the validation programs and development of the caring standards on one hand and continuous assessment of using these standards on the other hand.
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http://dx.doi.org/10.15171/jcvtr.2016.14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4970574PMC
August 2016

Moderate Patient-Prosthesis Mismatch Has No Negative Effect on Patients' Functional Status After Aortic Valve Replacement With CarboMedics Prosthesis.

Res Cardiovasc Med 2016 May 5;5(2):e29038. Epub 2016 Mar 5.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Background: Patient-prosthesis mismatch (PPM) after aortic valve replacement (AVR) is the subject of continuing debate in the cardiac surgery field.

Objectives: The aim of this study was to evaluate the frequency and severity of patient-prosthesis mismatch (PPM) and the functional status of patients undergoing aortic valve replacement (AVR) using a CarboMedics prosthesis in the mid-term follow up.

Patients And Methods: We retrospectively studied 66 consecutive patients who were referred to AVR with a CarboMedics prosthesis at the Rajaie cardiovascular medical and research center, a university referral hospital in Tehran, Iran. The severity of PPM as well as clinical and echocardiographic parameters and the patients' New York heat association (NYHA) functional classification status, operative data and postoperative complications, and mortality in a mid-term (4 - 5 months) follow up period was assessed. Severe PPM was defined as the effective orifice area (EOA) indexed to the patient's body surface area (BSA) < 0.65 cm(2)/m(2) and moderate PPM was defined as the indexed effective orifice area (IEOA) between 0.65 and 0.85 cm(2)/m(2).

Results: Of the 66 studied patients, 39 were male and 27 were female. The mean age of the patients was 43 ± 17 with a range of 6 - 76 years. Implanted sizes of the CarboMedics AV prosthesis in 22 patients were 19 and 21 mm, and in 44 patients were 23 and 25 mm. Eleven patients had moderate PPM (IEOA < 0.85 cm(2)/m(2)) and 55 of them did not have PPM (IEOA ≥ 0.85 cm(2)/m(2)). There were no statistically significant differences between the two groups in the echocardiographic trans-aortic pressure gradients (35.6 ± 19 vs. 23.2 ± 16 mmHg; P = 0.061) and the mean NYHA functional classification (1.10 ± 0.3 vs. 1.01 ± 0.10; P = 0.074) after AVR in the mid-term follow up.

Conclusions: Moderate PPM has no negative effect on echocardiographic trans-aortic pressure gradients or the patients' NYHA functional status after AVR with a CarboMedics prosthesis in the mid-term follow up.
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http://dx.doi.org/10.5812/cardiovascmed.29038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4756227PMC
May 2016

Feto-maternal outcomes of urgent open-heart surgery during pregnancy.

J Heart Valve Dis 2015 Mar;24(2):253-9

Background And Aim Of The Study: Cardiac surgery during pregnancy is rarely required and potentially increases feto-maternal mortality. The study aim was to evaluate pregnancy outcomes in females who underwent open-heart surgery with cardiopulmonary bypass (CPB) during pregnancy.

Methods: Between 1999 and 2014, a total of 16 pregnant women (mean age 27 ± 7 years; mean gestational age 13 ± 7.7 weeks) underwent urgent cardiac surgery using CPB. The preoperative diagnosis included prosthetic valve dysfunction in 12 women (five aortic, seven mitral), native valve endocarditis and critical aortic stenosis each in one woman, and intracardiac masses in two women. Eleven patients were in the first trimester, three in the second trimester, and two in the third trimester. A retrospective analysis was conducted that included maternal variables of age, gestational age, cardiac diagnosis, prior operations, surgical details, maternal morbidity and mortality and type of delivery, while fetal variables included incidence of low birth weight, prematurity, and fetal malformation. Patients were allocated to two groups: Group A (n = 9) included pregnant women with living neonates, while group B (n = 7) included pregnant women with an aborted fetus or dead neonate. All data were compared between the groups.

Results: There was no in-hospital maternal mortality. There were no significant differences between the two groups regarding age, gestational age, previous cardiac operation, type of surgery, duration of operation, perfusion pressure and core temperature during CPB. The CPB time was longer in group B (110.3 ± 57.1 min) than in group A (62 ± 15.7 min) (p = 0.028), as was the aortic cross-clamp time (54.3 ± 27.2 min and 38.7 ± 9.3 min in groups A and B, respectively) (p = 0.014). Group B patients received higher doses of inotropes perioperatively. No congenital abnormalities were identified in any of the living neonates.

Conclusion: The durations of CPB and aortic cross-clamping may not affect maternal outcome, but shorter CPB and aortic cross-clamp times led to better fetal outcomes. Increasing the perioperative dosage of inotropes may lead to a reduced fetal survival.
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March 2015

A rare presentation of late right coronary artery spasm following aortic valve replacement.

ARYA Atheroscler 2015 Jan;11(1):50-3

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Coronary artery spasm (CAS) is defined as a reversible, sudden epicardial coronary artery stenosis that causes vessel occlusion or near occlusion.

Case Report: In this article, we present a clinical case of CAS in a 48-year-old woman undergoing elective aortic valve replacement surgery for aortic stenosis. On the 3rd post-operative day, the patient suffered from chest pain and dyspnea. Emergent coronary angiography demonstrated a significant spasm of the ostium portion of the right coronary artery.

Conclusion: This case shows that delayed coronary spasm should be considered as a cause of hemodynamic instability after valvular surgery.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460353PMC
January 2015

Mid-Term Patency in Radial Artery and Saphenous Vein After Coronary Artery Bypass Grafting in Asymptomatic Patients Using 128-Slice CT Coronary Angiography.

Anesth Pain Med 2015 Feb 1;5(1):e23799. Epub 2015 Feb 1.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.

Background: Patency of the revascularization conduit is an essential predictor of long-standing survival after coronary artery bypass grafting.

Objectives: We have conducted this study to compare the mid-term patency rates of radial artery (RA), left internal thoracic artery (LITA) and also saphenous vein (SV) grafts in asymptomatic patients following coronary artery bypass graft surgery (CABG) undergoing total IV anesthesia.

Patients And Methods: In this study, 30 three-vessel disease patients with 104 RA, LITA, and SV grafts used concomitantly for primary isolated non-emergent CABG surgery were assessed. The primary end point was CT angiographic graft patency rate. After 53.5 (24-97) months' follow-up, graft patency was assessed using 128-slice CT coronary angiography. Logistic regression analysis was used to detect the independent predictors of graft failure.

Results: A total of 104 grafts, including 30 LITA, 44 SV, and 30 RA grafts, were studied. Cumulative graft patency rates were 93.3% in LITA, 83.3% in RA, and 70.5% in SV grafts. Statistically significant difference was found between the LITA and the SV graft patency rates (P = 0.019), whereas the difference between the RA conduit patency and the LITA or SV graft patency rates did not have any statistical significance (P = 0.424 and P = 0.273, respectively). Independent predictors of RA grafts occlusion were native coronary stenosis < 70% and female gender.

Conclusions: In our patients, the RA grafts had an acceptable patency rate in 2 to 5 years' follow-up. Although the SV grafts had a relatively higher patency rate than RA grafts in our asymptomatic patients, the patency rates in RA and SV grafts were close to each other. The RA graft function was poor in the patients with a higher number of risk factors and in the females.
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http://dx.doi.org/10.5812/aapm.23799DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4350187PMC
February 2015

Blood transfusion practice in a referral cardiovascular center in tehran, iran: a critical point of view.

Res Cardiovasc Med 2014 Nov 14;3(4):e21772. Epub 2014 Oct 14.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Background: Unnecessary perioperative transfusions are likely to be related to increased morbidity and additional costs in cardiac surgery.

Objectives: The aim of this study was to evaluate the blood transfusion practice during and after adult cardiac surgery in a referral university hospital in Iran.

Patients And Methods: In a descriptive study, we collected data from 153 adult patients underwent cardiac surgery at Rajaie Cardiovascular Medical and Research Center, Tehran, Iran from January to March 2013. The variables were patients' demographic, operative and post-operative data and the numbers of transfused packed red blood cell (PC) units and fresh frozen plasma (FFP) during and after cardiac surgery. Then we evaluated patients' and physicians' related causes of relatively increased transfusion rate in our patients and compared them with literature.

Results: Of 153 patients, 96.8% received PC and 54.9% transfused FFP during or after surgery. Most of the transfusions were done after operation in intensive care unit (ICU). Also, 20% and 17% of the patients underwent transfusion of more than 6 units of PC and FFP, respectively. The mean left ventricular ejection fraction of the patients was 42.5 ± 10.9%. A significant number of patients had anemia (especially women) or received anticoagulants or antiplatelet agents preoperatively. Thirteen percent of the patients underwent emergency operations and 12.3% had re-exploration.

Conclusions: The results of this study demonstrate that the cardiac surgery patients receive a relatively greater number of PC or FFP units during and after the operation in our center. This finding may be explained to some extent by the fact that the sicker and more co-morbid patients referred to our center and such patients are more anemic and undergoing more emergent and complex procedures. Moreover, Transfusion strategy or protocol should be updated, especially after the operation in ICU.
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http://dx.doi.org/10.5812/cardiovascmed.21772DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4347724PMC
November 2014

Rotational thromboelastometry in prediction of bleeding after cardiac surgery.

Asian Cardiovasc Thorac Ann 2015 Jun 12;23(5):525-9. Epub 2015 Jan 12.

Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran

Background: Reexploration and its associated complications significantly affect hospital mortality and morbidity. Therefore, to prevent postoperative bleeding and its related complications, using an appropriate modality is essential during cardiac surgery.

Methods: Four hundred patients (296 males and 104 females, mean age 60.8 ± 9 years) scheduled for first-time coronary artery bypass graft surgery were prospectively enrolled. Blood samples were obtained for ROTEM testing before surgery and 30 min after heparin reversal. The patients were divided into 2 groups: group 1 was patients with no abnormal postoperative bleeding and group 2 was patients who required reexploration for abnormal postoperative bleeding. Group 2 patients were divided into 2 subgroups: 2a was patients with surgical bleeding and group 2b was patients with nonsurgical bleeding. Variables were compared between groups.

Results: Among the 400 patients, 42 were reexplored. Hospital stay was significantly longer and hospital deaths more frequent in group 2 patients (p < 0.001 and p = 0.010, respectively). Ten (2.8%) patients had abnormal preoperative results of ROTEM in group 1 compared to 14 (33.3%) in group 2 (p < 0.001). After surgery, the number of patients with abnormal ROTEM results was significantly different between the 2 groups: 6 (1.7%) in group 1 vs. 14 (33.3%) in group 2 (p < 0.001). Four (12.5%) patients in group 2a had abnormal preoperative ROTEM results compared to 10 (100%) in group 2a (p < 0.001).

Conclusion: Measuring coagulation factors by ROTEM both before surgery and after heparin reversal can identify patients at increased risk of postoperative bleeding.
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http://dx.doi.org/10.1177/0218492314566330DOI Listing
June 2015

Prevention of edema after coronary artery bypass graft surgery by compression stockings.

Res Cardiovasc Med 2014 May 1;3(2):e17463. Epub 2014 Apr 1.

Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

Background: Lower limb edema may occur after removal of the saphenous veins in coronary artery bypass graft (CABG) surgery. Compression therapy is often used to prevent postoperative edema.

Objectives: The objective of this study was to evaluate the efficacy of medical compression stockings (TED) on the prevention of donor limbs edema and wound complications after CABG surgery.

Patients And Methods: In this prospective cohort study, we enrolled 100 patients who underwent elective CABG surgery at Rajaie Cardiovascular Medical and Research Center. The patients were divided into two groups; group A who applied TED stockings regularly (exposure group) and group B who did not apply TED stockings at all or apply it irregularly (no exposure group). The degree of donor limb edema and the differences of the peripheries of calf and thigh before and after the surgery (in 1, 2 and 4 weeks) were recorded and analyzed statistically.

Results: The patients' weight (P = 0.02) and the degree of their daily activity (P = 0.002) were the significant factors for the incidence of the donor limbs edema. The incidence and degree of lower limb edema were significantly lower in exposure group 4 weeks after the surgery (P < 0.001). The differences of the periphery of the calf before (at admission time) and after the surgery (in 1, 2 and 4 weeks) between two groups were also statistically significant (P = 0.41, P = 0.39, P = 0.40, respectively). Lower limb wound complications was higher in patients who have peripheral edema in the 4th week of post-CABG (P = 0.09).

Conclusions: Regular use of TED stockings may have positive effects on the prevention of donor limb edema (especially higher degrees of edema) and wound complications after CABG surgery.
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http://dx.doi.org/10.5812/cardiovascmed.17463DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253792PMC
May 2014