National clinical and financial outcomes associated with acute kidney injury following esophagectomy for cancer.

Background: Esophagectomy is a complex oncologic operation associated with high rates of postoperative complications. While respiratory and septic complications have been well-defined, the implications of acute kidney injury (AKI) remain unclear. Using a nationally representative database, we aimed to characterize the association of AKI with mortality, resource use, and 30-day readmission.

Center-Level Variation in Hospitalization Costs of Transcatheter Aortic Valve Replacement.

Background: Using a nationally representative database, the present study evaluated the degree of center-level variation in the cost of transcatheter aortic valve replacement (TAVR).

Methods: All adults undergoing elective, isolated TAVR were identified in the 2016 to 2018 Nationwide Readmissions Database. Multilevel mixed-effects models were used to identify patient and hospital characteristics associated with hospitalization costs.

Impact of Pulmonary Complications on Outcomes and Resource Use After Elective Cardiac Surgery.

Objective: To characterize the impact of pulmonary complications (PCs) on mortality, costs, and readmissions after elective cardiac operations in a national cohort and to test for hospital-level variation in PC.

Background: PC after cardiac surgery are targets for quality improvement efforts. Contemporary studies evaluating the impact of PC on outcomes are lacking, as is data regarding hospital-level variation in the incidence of PC.

Retained entrapped coronary stent appearing like an aortic flap.

Entrapment of coronary angioplasty hardware is a rare but serious complication of coronary interventions which may be managed percutaneously or surgically. We described a case of an entrapped coronary stent in a patient with a history of failed coronary intervention with no documents available. In transesophageal echocardiography, there was a linear echo density in the ascending aorta stuck in the right coronary artery resembling a dissection flap but based on the history of failed coronary intervention, this odd structure was supposed to be a retained angioplasty device.

Ruptured mitral valve aneurysm: A devastating complication of aortic valve endocarditis.

Mitral valve aneurysm is a rare clinical entity that is mostly resulted from infective endocarditis, in particular, aortic valve endocarditis. Once mitral valve aneurysm ruptures and severe mitral regurgitation and hemodynamic instability develop, prompt surgery should be considered. Here we report a patient with ruptured mitral valve aneurysm associated with native aortic valve endocarditis that was improved after a successful mitral and aortic valve replacement surgery associated with antibiotic therapy for 6 weeks.

Endovascular Aortic Aneurysm and Dissection Repair (EVAR) in Iran: Descriptive Midterm Follow-up Results.

Background: Endovascular repair of aorta in comparison to open surgery has a low early operative mortality rate, but its long-term results are uncertain.

Objectives: 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 Methods: 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.

Early outcome of off-pump versus on-pump coronary revascularization.

Introduction: The use of coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB) or without CPB technique (off-pump) can be associated with different mortality and morbidity and their outcomes remain uncertain. The goal of this study was to evaluate the early outcome of on-pump versus off-pump CABG.

Methods: We conducted a retrospective database review of 13866 patients (13560 patients undergoing on-pump CABG and 306 patients undergoing off-pump CABG) at Tehran Heart Center between January 2002 and January 2007.

Histopathologic insight into saphenous vein bypass graft disease.

Objectives: Vein graft disease is a major drawback of coronary artery bypass grafting. However, histopathologic studies of old human aortocoronary grafts are scarce.

Methods: We screened patients undergoing redo coronary artery bypass grafting at three university hospitals and selected those with at least one excisable old vein graft.

Extraluminal atherosclerosis: an under-recognised finding in human aortocoronary venous bypass grafts.

Background: Coronary artery bypass grafting (CABG) is commonly compromised by graft atherosclerosis. Histopathologic studies confirm various forms of atherosclerosis, including positively remodelled lesions in native coronary arteries but there are no histopathologic reports of extraluminal atherosclerosis in vein grafts.

Methods: We prospectively investigated the histopathologic presence and pattern of extraluminal atherosclerosis in human old vein grafts in a two-year interval among patients undergoing redo-CABG at three university hospitals in Tehran.

Predictors and early outcome of prolonged mechanical ventilation in contemporary heart valve surgery.

Background: During last decades mechanical ventilation has been an important support in the postoperative management of patients undergoing cardiac surgery. This study was designed to determine the predictors of prolonged mechanical ventilation (PMV) in patients undergoing heart valve surgery.

Methods: This retrospective study considered of 1056 patients who underwent isolated valve surgery at Tehran Heart Center from March 2002 to March 2009.

Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery.

Introduction And Objectives: Atrial arrhythmias occur after cardiac surgery in 10-65% of patients. The most common postoperative arrhythmia is atrial fibrillation (AF).

Methods: The Tehran Heart Center Cardiovascular Research database (of 15 580 patients) was used to identify all patients who developed any form of AF as a postoperative complication following their first cardiac surgery (e.

Relationship between body mass index and left main disease: the obesity paradox.

Background And Aims: Obesity is a well-known risk factor for development of diabetes, hypertension, and coronary artery disease. However, the obesity paradox shows that short-term outcome has been reported to be superior after revascularization in overweight patients. We conducted this study to examine this theory in patients who were candidates for coronary artery bypass graft and to determine if there is a relationship between obesity and the severity of coronary artery involvement and left main disease in Iranian patients.

The association of opium dependence and postoperative complications following coronary artery bypass graft surgery: a propensity-matched study.

Objective: Opium is an overwhelming public health problem in some countries. Different studies have suggested this drug as a risk factor for cardiovascular disease. Although the effect of opium on immune system, lung disease, nephropathy, stroke, and cardiac arrhythmia has been found in different studies, its effect on postoperation complications is not clear yet.

Is severely left ventricular dysfunction a predictor of early outcomes in patients with coronary artery bypass graft?

Background: Traditionally, the Coronary artery bypass grafting (CABG) surgery outcomes of patients with low ejection fraction (EF) have been worse compared to patients with moderate to good left ventricular function. During the past decade, despite improvements in surgical techniques, the trend in the outcomes of these patients remained unclear.

Aim: We sought to determine the effect of left ventricular dysfunction on early mortality and morbidity and to specify predictors of early mortality of isolated CABG in a large group of patients EF≤35%.

Screening of carotid artery stenosis in coronary artery bypass grafting patients.

Background: We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting.

Methods: 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.

Comparison of compression stocking with elastic bandage in reducing postoperative edema in coronary artery bypass graft patient.

The removal of the saphenous veins in coronary artery bypass graft (CABG) surgery may cause leg edema. Compression therapy is often used to prevent postoperative edema. The objective of this study was to compare the efficacy of medical compression stocking (TED) and elastic bandage-type on donor limbs after CABG.

Traditional cardiac risk factors profile in Iranian patients undergoing coronary artery bypass surgery.

Objective: It is well known that the traditional cardiac risk factors (TCRFs) affect short-term and long-term outcome following coronary artery bypass graft surgery (CABG). The objective of this study was to detect the prevalence of these risk factors i.e.

Determinant factors of renal failure after coronary artery bypass grafting with on-pump technique.

Objective: The aim of the present study was to investigate the determinant factors of acute renal failure (ARF) after isolated on-pump coronary artery bypass grafting (CABG).

Subjects And Methods: This was a retrospective study of 13,315 adult patients who underwent isolated CABG with cardiopulmonary bypass (CPB) in Tehran Heart Center from May 2002 to May 2007. The exclusion criteria were age <18, concomitant cardiac and/or noncardiac surgical operations, history of renal failure before surgery, and chronic renal failure requiring dialysis.

Inflammatory myofibroblastic tumor of the right ventricle causing tricuspid valve regurgitation.

Cardiac inflammatory myofibroblastic tumor is a rare lesion consisting of inflammatory cells and myofibroblastic spindle cells. We describe a case of inflammatory myofibroblastic tumor that involved the right ventricle, thereby causing tricuspid valve regurgitation in an 18-year-old man who presented with a fever of unknown origin and of 1 month's duration. With the patient on cardiopulmonary bypass, we excised the lesion and replaced the tricuspid valve without serious intraoperative or postoperative sequelae.

Short- and mid-term results of triple-valve surgery with an evaluation of postoperative quality of life.

The decision to proceed with triple-valve surgery should take into account reasonable estimates of the risk of the surgery and of the potential benefit to be gained. In the present study, we reviewed our experience with triple-valve surgery, focusing on short-term death and morbidity, mid-term survival, and postoperative quality of life.Among 107 patients with multiple-valve disease who underwent triple-valve surgery at Tehran University Heart Center from January 2002 through December 2007, 100 patients with complete, recorded data were entered into the study.

Is preoperative serum creatinine a reliable indicator of outcome in patients undergoing coronary artery bypass surgery?

Objective: Evaluating renal function by calculating creatinine clearance as an alternative measure to serum creatinine may give a better estimation of postoperative renal function in patients undergoing coronary artery bypass grafting.

Methods: Using our database, we conducted a retrospective review of the records of all 11,884 patients aged 21 years or older undergoing pure bypass grafting who required cardiopulmonary bypass. Preoperative renal function was categorized as normal renal function (serum creatinine View Article and Find Full Text PDF

Atherosclerosis and vascular injury: the effect of a perivascular nitric oxide donor in a cholesterol-fed rabbit model.

Nitric oxide (NO) has been shown to prevent neointimal hyperplasia and decrease atherosclerosis in several animal models. It is a major modulator of vascular homeostasis and has vasoprotective effects against atherosclerosis. However, NO-based therapies with such purposes have not been used in the clinical arena.