Publications by authors named "Alexander Kogan"
Immunodetection of cardiac isoforms of troponin I (cTnI) and troponin T (cTnT) in blood samples is widely used for the diagnosis of acute myocardial infarction. The cardiac troponin complex (ITC-complex), comprising cTnI, cTnT, and troponin C (TnC), makes up a large portion of troponins released into the bloodstream after the necrosis of cardiomyocytes. However, the stability of the ITC-complex has not been fully investigated.
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- The war that started on October 7, 2023, has led to an unexpected rise in open-heart surgeries at Israel's largest cardiac surgery department, despite half of the surgeons being in military service.
- A study analyzed data from 275 patients who had cardiac surgeries or ECMO during the first two months of the war, comparing it to a similar period in 2022.
- Results showed a 33% increase in open-heart procedures and a significant rise in transplants in 2023, but patient outcomes, including complications and mortality rates, remained consistent with those from 2022.
Surgical Ablation for Atrial Fibrillation: Risk Factors for Recurrence and Long-Term Outcome.
J Cardiothorac Vasc Anesth
September 2024
Article Synopsis
- Atrial fibrillation (AF) is a common heart rhythm disorder, and this study explores the effectiveness of surgical ablation as a treatment option, especially for patients also undergoing other cardiac surgeries.
- The research involved 668 patients who underwent this procedure between 2006 and 2022, assessing their outcomes over multiple years, including recurrence of AF and mortality rates.
- Results showed high success rates for maintaining freedom from AF, with success decreasing slightly over 7 years, while factors like age, female sex, and diabetes were linked to higher risks of recurrence and mortality.
Objectives: Heparin is a highly charged polysaccharide used as an anticoagulant to prevent blood coagulation in patients with presumed myocardial infarction and to prepare heparin plasma samples for laboratory tests. There are conflicting data regarding the effects of heparin on the measurement of cardiac isoforms of troponin I (cTnI) and troponin T (cTnT), which are used for the immunodiagnosis of acute myocardial infarction. In this study, we investigated the influence of heparin on the immunodetection of human cardiac troponins.
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- The study analyzed the use of extracorporeal membrane oxygenation (ECMO) in pregnant women experiencing severe respiratory or circulatory failure across 10 hospitals in Israel over three years.
- Out of 540,234 live births, only 28 obstetric patients (5.2 per 100,000 births) were treated with ECMO, primarily for hypoxic respiratory failure due to conditions like ARDS, with COVID-19 being a significant factor.
- Despite the low incidence, ECMO resulted in high survival rates for both mothers (89.3%) and babies (100%), with complications being rare.
Article Synopsis
- - Severe respiratory failure from COVID-19 often necessitates mechanical ventilation and can involve ECMO; lung transplantation is a rare last resort with unclear patient selection and timing.
- - A study of 20 patients supported by ECMO found that 16 remained for analysis, revealing that nine recovered while seven died while waiting for lung transplantation.
- - Younger patients showed a better recovery chance without lung transplantation after about 59 days on ECMO compared to a median of 99 days for those who died, suggesting a delay of 8-10 weeks for referral to transplantation for potentially recoverable patients.
Article Synopsis
- Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, linked to higher mortality and complications, but the long-term recurrence rate is not well-understood.
- The study followed 22 patients with POAF, using either an implanted loop recorder or ECG monitoring to track AF recurrence over two years, finding about 35.7% experienced recurrence.
- Results showed no significant difference between monitoring methods, with patients receiving anticoagulation treatment, and no major adverse events like mortality or strokes reported, indicating a need for further research on monitoring methods in this patient group.*
TACROLIMUS, a mainstay of immunosuppression after orthotopic heart transplantation (OHT), is associated with a broad range of side effects. Vasoconstriction caused by tacrolimus has been proposed as a mechanism underlying common side effects such as hypertension and renal injury. Neurologic side effects attributed to tacrolimus include headaches, posterior reversible encephalopathy syndrome (PRES), or reversible cerebral vasospasm syndrome (RCVS).
View Article and Find Full Text PDFSurgical ablation for atrial fibrillation: impact of Diabetes Mellitus type 2.
Cardiovasc Diabetol
March 2023
Article Synopsis
- Diabetes type 2 is associated with higher health risks and complications in patients undergoing surgical ablation for atrial fibrillation (AF), particularly older age and higher rates of conditions like hypertension and stroke.
- A study involving 606 patients compared outcomes between non-diabetic and diabetic patients after AF ablation, revealing similar short-term AF recurrence and mortality rates within the first 3 years, but a notably higher 5-year mortality rate in diabetic patients.
- The findings suggest that while surgical ablation is effective for both groups, long-term outcomes may be less favorable for patients with diabetes type 2.
Background: Blood measurement of cardiac troponin T (cTnT) is one of the most widespread methods of acute myocardial infarction (MI) diagnosis. cTnT degradation may have a significant influence on the precision of cTnT immunodetection; however, there are no consistent data describing the level and sites of cTnT proteolysis in the blood of MI patients. In this study, we bordered major cTnT fragments and quantified their relative abundance in the blood at different times after MI.
View Article and Find Full Text PDFEarly tracheostomy after cardiac surgery improves intermediate- and long-term survival.
Med Intensiva (Engl Ed)
September 2023
Article Synopsis
- This study looked at how the timing of a procedure called tracheostomy (a way to help people breathe after heart surgery) affects how long patients live after surgery.
- It found that having this procedure done early (within 4-10 days) is linked to better survival compared to those who had it done later.
- The study also kept track of infections in patients' wounds, but the main finding was that getting the tracheostomy sooner helps patients live longer after their surgery.
Article Synopsis
- The study examines the prevalence of heparin-induced thrombocytopenia (HIT) in critically ill COVID-19 patients, finding a significant association with severe clinical outcomes.
- Out of 107 patients, over half experienced thrombocytopenia, leading to complications such as increased ventilation needs, disseminated intravascular coagulation (DIC), and higher mortality rates.
- The research suggests that understanding HIT's role in COVID-19 is crucial due to its impact on immune response and coagulopathy, highlighting the need for precise treatment protocols.
Article Synopsis
- Ventricular tachycardia ablation (VTA) is challenging when patients have low blood pressure, but using veno-arterial extracorporeal membrane oxygenation (VA-ECMO) can help complete the procedure safely.
- A study gathered data from 46 patients who underwent VA-ECMO-assisted VTA, focusing on their medical history, procedure details, and outcomes, comparing those who were weaned off VA-ECMO immediately versus those who were not.
- Results showed that early de-cannulation from VA-ECMO was linked to significantly better survival rates after one year, highlighting the importance of timely weaning to reduce mortality risk.
Article Synopsis
- Type 2 diabetes is common among patients with infective endocarditis (IE) and this study aimed to assess its impact on mortality rates post-surgery for IE.
- The study analyzed data from 420 patients over 14 years, dividing them into diabetic (Group II) and non-diabetic (Group I) to compare their outcomes.
- While short- and intermediate-term mortality showed a trend towards being higher in diabetic patients, only 5-year mortality was significantly worse for diabetics, making diabetes a key factor in predicting long-term survival after treatment.
Article Synopsis
- The study aimed to assess the safety and effectiveness of preoperative levosimendan in patients receiving left ventricular assist devices (LVADs), focusing on outcomes like right ventricular failure (RVF) and in-hospital mortality.
- The analysis included 62 patients, dividing them into two groups: those treated with levosimendan and those who were not, finding similar rates and times for RVF, inotropic support, and length of hospital stays between both groups.
- The research concluded that while levosimendan was safe to use before LVAD implantation, it did not significantly improve post-operative outcomes compared to the control group.
Background: Diastolic plateau is an invasive hemodynamic marker of impaired right ventricular (RV) diastolic filling. The purpose of the current analysis was to evaluate the prognostic importance of this sign in left ventricular assist device (LVAD) patients.
Methods: The analysis included all LVAD patients who received continuous-flow LVAD (HeartMate 3) at the Sheba medical center and underwent right heart catheterization (RHC) during follow up post-LVAD surgery.
Objectives: Contemporary data on the prognostic impact of pre-existing left or right bundle branch block on clinical outcomes after aortic valve (AV) replacement are limited. The aim of this study was to evaluate the impact of pre-existing bundle branch block on clinical outcomes in patients undergoing AV replacement.
Methods: Data from patients who underwent AV replacement surgery between 2004 and 2020 were obtained from our departmental database.
Objectives: Type 2 diabetes mellitus (DM) is a frequent comorbidity among patients suffering from advanced heart failure necessitating a left ventricular assist device (LVAD) implant. The goal of this study was to evaluate the impact of type 2 DM on early and long-term outcomes of patients following an LVAD implant.
Methods: We performed an observational cohort study in a large tertiary care centre in Israel.
Article Synopsis
- The study examines the long-term outcomes of a ring-only repair (ROR) technique for treating severe mitral regurgitation (MR) caused by degenerative bileaflet valve issues, particularly Barlow's disease.
- Eighty patients were treated, with a notable follow-up period showing a very low recurrence rate of MR (1%) and high survival rates, indicating the effectiveness of ROR in this context.
- The findings suggest ROR is a safe and straightforward method for these patients, with minimal complications and a 10-year freedom from recurrent MR at 97%.
Background: Antiphospholipid syndrome (APS) may cause chronic thromboembolic pulmonary hypertension (CTEPH). Current knowledge regarding prevalence and risk factors for CTEPH among APS patients is limited. We sought to determine clinical features and biomarkers that could identify APS subjects suffering from CTEPH, and describe the prevalence, course and treatment outcomes of patients with APS-CTEPH.
View Article and Find Full Text PDFAs the coronavirus pandemic emerged in late 2019, a task force was founded in the Sheba Medical Center and began preparing for the arrival of the pandemic to Israel. Several wards were put in charge of isolated COVID-19 patients. A new intensive care unit was formed for the most critical COVID-19 patients, requiring mechanical ventilation and multi-organ treatment.
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- Acute aortic dissection and acute pulmonary embolism (PE) can show similar symptoms, making quick and accurate diagnosis essential for treatment.
- A case involved a 73-year-old woman who was initially diagnosed with aortic dissection and later found to have PE during her COVID-19 treatment.
- She underwent surgery for both conditions and was discharged without complications nine days later, highlighting how COVID-19 can increase the risk of these emergencies.
The Impact of Initiation of an Intensivist-Led Patient Management Protocol on Outcomes After Cardiac Surgery.
J Cardiothorac Vasc Anesth
August 2021
Article Synopsis
- A study was conducted to assess how a quality improvement program led by an intensivist could impact long-term mortality in high-risk patients who had prolonged ICU stays after cardiac surgery.
- The research compared outcomes of two groups of patients: one group treated before the program was introduced (2004-2007) and one after (2009-2014), finding a significant decrease in mortality rates among patients with prolonged ICU stays after the program's implementation.
- The findings indicate that the intensivist-led management approach effectively reduced long-term mortality rates, particularly for those staying in the ICU for seven days or more.