Emir Mujanovic - Academia.edu (original) (raw)
Papers by Emir Mujanovic
Medicinski arhiv, 2009
Study comparing the results of coronary artery bypass grafting (CABG) with and without cardiopulm... more Study comparing the results of coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB) in the treatment of left main stenosis (LMS) has not yet been made in Bosnia and Herzegovina. The main aim of this study was to compare result of CABG performed on 176 patients, in Cardiovacular clinic of University Clinical Center in Tuzla from May 1999 to January 2005, by these two methods in LMS group of patients in the early and late postoperative period. The study was divided in two parts. In the first part, early postoperative period (30 days after the surgery) has been analysed, which encompasses results of CABG in 92 patients revascularisied without CPB (OPCAB) method (Group A), and 84 patients with LMS revascularisied with CPB method (ONCAB, CCAB) (Group B). In the second part, late postoperative period (one year after surgery) has been analysed. Patients from both groups were contacted and interviewed. Total number (276 versus 278), same as average number of ...
Bosnian journal of basic medical sciences / Udruženje basičnih mediciniskih znanosti = Association of Basic Medical Sciences, 2008
This study investigated outcomes in patients undergoing coronary artery bypass grafting (CABG) wi... more This study investigated outcomes in patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), who needed conversion to CPB. Between September, 1998 and September, 2003, 1000 CABG procedures were performed in a Cardiovascular Clinic, University Clinical Centre Tuzla. Multivessel CABG were selected arbitrarily for CABG without CPB (OPCAB) or CABG with CPB (ONCAB). Patients who required conversion due to technical difficulty with grafting were performed with ONCAB including cardioplegic arrest. Patients with severe hemodynamic instability and cardiac arrest were performed as ONCAB without crossclamping, while patients converted for mild to moderate hemodynamic instability were given cardioplegic arrest or not, depending on surgeon preference. 493 operations were scheduled and performed as ONCAB (49.3%), 468 as OPCAB (46.8%) and 39 originally scheduled OPCAB operations were converted to ONCAB (7.7% of originally scheduled OPCAB patients or 3.9% of ...
Bosnian journal of basic medical sciences / Udruženje basičnih mediciniskih znanosti = Association of Basic Medical Sciences, 2007
The aim of this study was to analyze the Transit time flow measurement (TTFM) experience in the f... more The aim of this study was to analyze the Transit time flow measurement (TTFM) experience in the first 1000 CABG operations. First 1000 patients had coronary artery bypass grafting (CABG) performed in Cardiovascular Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina, between September, 1998 and September, 2003. CABG without use of cardiopulmonary bypass (CPB)-(OPCAB) was used as the preferential surgical method both because this method is reported to have equal or better results than CABG with use of CPB (ONCAB), and because of the significant cost savings realized. TTFM was routinely used in all grafts as a quality assurance measure. Criteria for a poor functioning graft were: low mean flow (MF), pulsatility index (PI) above 5 and a poor diastolic flow pattern. When no reversible cause of poor TTFM results were identified the graft was revised. A total of 1394 grafts in OPCAB group and 1478 in ONCAB group were performed. A total of 38 grafts (2,72%) in 37 patients (7,0...
Medicinski arhiv, 2004
This study reviewed the early experience with off-pump coronary artery bypass surgery in treatmen... more This study reviewed the early experience with off-pump coronary artery bypass surgery in treatment of patients with severe left main coronary artery stenosis. From May 2002-December 2003, 75 patients with significant left main coronary artery stenosis (> or = 50%) underwent coronary artery bypass grafting. 35 patients were operated without the use of cardiopulmonary bypass (OPCAB) and compared with 40 patients operated with the use of cardiopulmonary bypass (ONCAB). Mean age, ejection fraction and EUROSCORE were similar in both groups. Average grafts per patients was also similar (OPCAB 3.0 vs. ONCAB 3.2). The incubation time (3.1 vs. 5.8 hours), blood loss (445 vs. 610 ml) and hospital stay (6.8 vs. 8.1 days) were less in OPCAB group. There was no mortality in OPCAB group whereas 2 patients (5.0%) died in ONCAB group. Our early experience suggests that off-pump coronary artery bypass surgery is effective in treatment of patient with severe left main coronary artery stenosis and ...
Medicinski arhiv, 2002
Although it is possible to find a number of comparative studies in the world literature discussin... more Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit and total length of hospitalisation in two groups of patients operated with these methods. One hundred and four patients with coronary artery disease operated in Cardiovascular Clinic Tuzla, from September, 1998 to September 2002 divided in two groups, were included in this study. There were 52 patients in the first group operated with CPB and 52 patients in the second group operated without CPB. The groups were matched for gender, age, ejection fraction and preoperative risk factors. The incidence of postoperative complications was lower in patients operated without CPB (5....
The heart surgery forum, 2002
A new cardiovascular center in Tuzla, Bosnia Herzegovina was opened for cardiac procedures in Sep... more A new cardiovascular center in Tuzla, Bosnia Herzegovina was opened for cardiac procedures in September 1998. In the first three years of operation, a total of 440 coronary artery bypass grafting (CABG) procedures were performed there. Off-pump coronary artery bypass (OPCAB) was emphasized as the main tool for surgical revascularization. Transit time flow measurement (TTFM) was used routinely to check graft patency. The purpose of this paper is to report on flowmetry results in the Tuzla CABG population. All patients were considered candidates for both on-pump (ONCAB) and off-pump (OPCAB) CABG procedures. Approximately 60% of the procedures were performed as ONCAB and the rest as OPCAB. For all patients, TTFM was performed on all grafts. Eighteen patients were converted from OPCAB to ONCAB. Revision was required for 1.8% of the grafts. All grafts were successfully revised and were patent at the time of wound closure. We believe that TTFM is a crucial tool in CABG. It offers a reliab...
Medical Archives, 2015
The aortic valve replacement is a standard operating procedure in patients with severe aortic ste... more The aortic valve replacement is a standard operating procedure in patients with severe aortic stenosis. Structure of patients undergoing surgery ranges from young population with isolated mitral valvular disease to the elderly population, which is in addition to the underlying disease additionally burdened with comorbidity. One of the most commonly present factors that further complicate the surgery is coronary heart disease that occurs in, almost, one third of patients with aortic stenosis. The aim is to compare the results of surgery for aortic valve replacement with or without coronary artery bypass graft (CABG). From August 2008 to January 2013 in our center operated on 120 patients for aortic stenosis. Of this number, 75 were men and 45 women. The average age was 63.37 years (16-78). Isolated aortic valve replacement was performed in 89 patients and in 31 patients underwent aortic valve replacement and coronary bypass surgery. Implanted 89 biological and 31 mechanical valves. Patients with associated aortic stenosis and coronary artery disease were more expressed symptomatic symptoms preoperatively to patients with isolated aortic stenosis who were on average younger age. Intra-hospital morbidity and mortality was more pronounced in the group of patients with concomitant aortic valve replacement and coronary bypass surgery. Morbidity was recorded in 17 patients (14.3%) in both groups, while the mortality rate in both groups was 12 patients (10.1%). Evaluation of preoperative risk factors and comorbidity in patients with aortic stenosis and coronary artery disease contributes to a significant reduction in intraoperative and postoperative complications. Also, early diagnosis of associated coronary artery disease and aortic stenosis contributes to timely decision for surgery thus avoiding subsequent ischaemic changes and myocardial damage.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2009
: The purpose of this randomized study was to evaluate the effect on graft patency by adding clop... more : The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. : Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. : Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. : Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.
Medical Archives, 2013
To report our experience with the retroperitoneal and transperitoneal approaches of laparoscopic ... more To report our experience with the retroperitoneal and transperitoneal approaches of laparoscopic nephrectomy for renal cell carcinoma (RCC). Methods: Between July 2001 and December 2007, 100 patients with RCC underwent laparoscopic radical nephrectomy at our institution for clinically localized RCC. Fifty-three patients received a retroperitoneal procedure and 47 received a transperitoneal procedure. The perioperative and oncological outcomes of these groups were reviewed retrospectively. Results: Mean follow up was 34 months. No statistically significant difference was found between the two approaches in terms of pathological stage, operative time, need for additional procedures such as adrenalectomy and/or lymph node sampling, estimated blood loss, need for blood transfusions, analgesic requirement, length of hospital stay, or the incidence of minor or major complications. The 5-year disease-free survival rate was 90% for both the retroperitoneal and transperitoneal procedures. The 5-year overall survival rates were 98% and 96%, respectively. Therefore, no significant difference was observed in the long-term oncological outcome between the two groups. Conclusions: Tumor control and surgical morbidity in laparoscopic radical nephrectomy seem not to be significantly influenced by the approach.
Medical Archives, 2012
A natomical variations of veins often play a crucial role in formation of thrombotic changes in s... more A natomical variations of veins often play a crucial role in formation of thrombotic changes in superficial and deep veins of lower extremities. The aim of this study was to determine the frequency of the dominant type of the lower extremity superficial veins, and to determine the eventual influence of such variations to the formation of superficial and deep vein thrombosis (DVT). Material and methods: The sample used in this study consisted of 180 patients subjected to ascedent contrast phlebography of lower extremities. The total sample was divided into following groups: patients with and without variations of the lower extremity superficial veins. Results and discussion: Dominant type of the superficial veins (without variation) consisted of 97 patients (53.89%), while the rest of 83 patients showed some kind of anatomical variation (46.11%). The most frequent variation was the duplicated form of v. saphena magna in 53.85%, while this procentage in women was 57.89%. Most frequent variations of duplicated v. saphena magna were: simple duplicated form, closed loop form, branching form and combined form. Topographical variation of saphenopopliteal junction besides fossa poplitea in the group of men showed procentage of 53.85%, while in the group of women that value accounted 63.16%. Conclusion: The percentage of varicose veins was more frequent in men and women without variations, but deep vein DVT showed higher frequency in patients with anatomical variations of superficial veins of lower extremities.
Medical Archives, 2011
W e present a case of 71 year old man operated in our clinic for ruptured abdominal aneurysm comp... more W e present a case of 71 year old man operated in our clinic for ruptured abdominal aneurysm complicated with aorto-caval fistula, which was revealed during the surgery and successfully repaired by direct sutures within the aorta. This is the first record of the aorto-caval fistula that was so far noticed in our clinic. Urgent surgery and repair of the defect conneting aorta and vena cava by direct sutures within the aorta followed by ruptured aneurysm repair with tube graft is only way of treatment. Despite its infrequent occurrence, aorto-caval fistula should always be considered in any case of ruptured abdominal aneurysm.
Medical Archives, 2013
T he number of patients undergoing coronary artery bypass grafting (coronary artery bypass grafti... more T he number of patients undergoing coronary artery bypass grafting (coronary artery bypass grafting-CABG) older than 70 years is increasing. Cardiac surgeons are investigate applicability of alternative and less invasive methods such as surgery without the use of cardiopulmonary bypass (CPB). The aim of this study was to compare the peri-and postoperative results of CABG in elderly patients operated with and without CPB. Patients and Methods: The study included subjects older than 70 years, who underwent coronary bypass surgery at the BH Heart Center Tuzla in the period from August 2008 to August 2010, divided into two groups. Group A consisted of 50 patients operated without CPB, group B 50 patients operated with CPB, adjusted by sex, left ventricular ejection fraction values, EuroSCORE, and the number of bypass grafts was made . Results: In the group treated without the use CPB there were significantly lower values of the time-duration of mechanical ventilation, length of stay in the Intensive Care Unit (ICU), the amount of postoperative bleeding and blood recovered, the length of hospital stay, levels of serum creatinine, C-reactive protein and creatine kinase MB fraction. Conclusion: CABG without the use of CPB has a number of advantages over the method with CPB in elderly patients, which is evident from the lower values of renal and inflammatory parameters and markers of myocardial lesion, less time spent on a ventilator, shorter length of stay in the ICU and total hospitalization time, less postoperative bleeding and blood transfusion.
Medical Archives, 2014
Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wa... more Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction, occurring in approximately 4% of patients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients.
Minimally Invasive Therapy & Allied Technologies, 2011
The present article will review new technology in the invasive approach to mitral valvular diseas... more The present article will review new technology in the invasive approach to mitral valvular disease. Mitral valve pathology continues to present an important challenge to the cardiac surgeon and interventionalist. From the early days of closed mitral valvular commisurotomy, a number of new approaches to this valve have been developed. Mitral stenosis was previously approached through a minimally invasive beating heart surgical approach, but may now be treated with either catheter-based or open surgical techniques. Regurgitation, which has become the leading pathology of the mitral valve in the developed world, may be approached through traditional cardiac surgery or through catheter-based techniques. New imaging techniques and device innovation will cause drastic changes in therapy for mitral valvular disease in the foreseeable future.
Journal of Thoracic and Cardiovascular Surgery, 2004
The objective of this study was to investigate the patency in saphenous vein coronary bypass graf... more The objective of this study was to investigate the patency in saphenous vein coronary bypass grafts in which the proximal anastomoses were performed with automatic connector devices or with a traditional suture technique.
Heart, Lung and Circulation, 2010
We have previously demonstrated that transittime flow measurements (TTFM) reliably predict the ne... more We have previously demonstrated that transittime flow measurements (TTFM) reliably predict the need for revision of coronary grafts during off-pump coronary artery bypass grafting (OPCAB). The present study tested whether TTFM may predict graft patency at three months.
Heart, Lung and Circulation, 2007
ABSTRACT
The Annals of Thoracic Surgery, 2007
Background. Bosnia and Herzegovina did not have invasive cardiac diagnosis or cardiac surgery bef... more Background. Bosnia and Herzegovina did not have invasive cardiac diagnosis or cardiac surgery before the recent war. With assistance from the United States and Norway, a cardiovascular clinic was developed. This study reports center-specific and surgeon-specific clinical outcomes. Since off-pump coronary bypass grafting surgery was prioritized in the treatment of coronary disease, a comparison was made between operations performed with and without cardiopulmonary bypass.
Medicinski arhiv, 2009
Study comparing the results of coronary artery bypass grafting (CABG) with and without cardiopulm... more Study comparing the results of coronary artery bypass grafting (CABG) with and without cardiopulmonary bypass (CPB) in the treatment of left main stenosis (LMS) has not yet been made in Bosnia and Herzegovina. The main aim of this study was to compare result of CABG performed on 176 patients, in Cardiovacular clinic of University Clinical Center in Tuzla from May 1999 to January 2005, by these two methods in LMS group of patients in the early and late postoperative period. The study was divided in two parts. In the first part, early postoperative period (30 days after the surgery) has been analysed, which encompasses results of CABG in 92 patients revascularisied without CPB (OPCAB) method (Group A), and 84 patients with LMS revascularisied with CPB method (ONCAB, CCAB) (Group B). In the second part, late postoperative period (one year after surgery) has been analysed. Patients from both groups were contacted and interviewed. Total number (276 versus 278), same as average number of ...
Bosnian journal of basic medical sciences / Udruženje basičnih mediciniskih znanosti = Association of Basic Medical Sciences, 2008
This study investigated outcomes in patients undergoing coronary artery bypass grafting (CABG) wi... more This study investigated outcomes in patients undergoing coronary artery bypass grafting (CABG) without cardiopulmonary bypass (CPB), who needed conversion to CPB. Between September, 1998 and September, 2003, 1000 CABG procedures were performed in a Cardiovascular Clinic, University Clinical Centre Tuzla. Multivessel CABG were selected arbitrarily for CABG without CPB (OPCAB) or CABG with CPB (ONCAB). Patients who required conversion due to technical difficulty with grafting were performed with ONCAB including cardioplegic arrest. Patients with severe hemodynamic instability and cardiac arrest were performed as ONCAB without crossclamping, while patients converted for mild to moderate hemodynamic instability were given cardioplegic arrest or not, depending on surgeon preference. 493 operations were scheduled and performed as ONCAB (49.3%), 468 as OPCAB (46.8%) and 39 originally scheduled OPCAB operations were converted to ONCAB (7.7% of originally scheduled OPCAB patients or 3.9% of ...
Bosnian journal of basic medical sciences / Udruženje basičnih mediciniskih znanosti = Association of Basic Medical Sciences, 2007
The aim of this study was to analyze the Transit time flow measurement (TTFM) experience in the f... more The aim of this study was to analyze the Transit time flow measurement (TTFM) experience in the first 1000 CABG operations. First 1000 patients had coronary artery bypass grafting (CABG) performed in Cardiovascular Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina, between September, 1998 and September, 2003. CABG without use of cardiopulmonary bypass (CPB)-(OPCAB) was used as the preferential surgical method both because this method is reported to have equal or better results than CABG with use of CPB (ONCAB), and because of the significant cost savings realized. TTFM was routinely used in all grafts as a quality assurance measure. Criteria for a poor functioning graft were: low mean flow (MF), pulsatility index (PI) above 5 and a poor diastolic flow pattern. When no reversible cause of poor TTFM results were identified the graft was revised. A total of 1394 grafts in OPCAB group and 1478 in ONCAB group were performed. A total of 38 grafts (2,72%) in 37 patients (7,0...
Medicinski arhiv, 2004
This study reviewed the early experience with off-pump coronary artery bypass surgery in treatmen... more This study reviewed the early experience with off-pump coronary artery bypass surgery in treatment of patients with severe left main coronary artery stenosis. From May 2002-December 2003, 75 patients with significant left main coronary artery stenosis (> or = 50%) underwent coronary artery bypass grafting. 35 patients were operated without the use of cardiopulmonary bypass (OPCAB) and compared with 40 patients operated with the use of cardiopulmonary bypass (ONCAB). Mean age, ejection fraction and EUROSCORE were similar in both groups. Average grafts per patients was also similar (OPCAB 3.0 vs. ONCAB 3.2). The incubation time (3.1 vs. 5.8 hours), blood loss (445 vs. 610 ml) and hospital stay (6.8 vs. 8.1 days) were less in OPCAB group. There was no mortality in OPCAB group whereas 2 patients (5.0%) died in ONCAB group. Our early experience suggests that off-pump coronary artery bypass surgery is effective in treatment of patient with severe left main coronary artery stenosis and ...
Medicinski arhiv, 2002
Although it is possible to find a number of comparative studies in the world literature discussin... more Although it is possible to find a number of comparative studies in the world literature discussing the results of coronary artery bypass surgery (CABG) with and without cardiopulmonary bypass (CPB), until now such analysis has not been made in Bosnia and Herzegovina. The main aim of this scientific work was to compare morbidity and mortality, need for blood transfusions, length of stay in the intensive care unit and total length of hospitalisation in two groups of patients operated with these methods. One hundred and four patients with coronary artery disease operated in Cardiovascular Clinic Tuzla, from September, 1998 to September 2002 divided in two groups, were included in this study. There were 52 patients in the first group operated with CPB and 52 patients in the second group operated without CPB. The groups were matched for gender, age, ejection fraction and preoperative risk factors. The incidence of postoperative complications was lower in patients operated without CPB (5....
The heart surgery forum, 2002
A new cardiovascular center in Tuzla, Bosnia Herzegovina was opened for cardiac procedures in Sep... more A new cardiovascular center in Tuzla, Bosnia Herzegovina was opened for cardiac procedures in September 1998. In the first three years of operation, a total of 440 coronary artery bypass grafting (CABG) procedures were performed there. Off-pump coronary artery bypass (OPCAB) was emphasized as the main tool for surgical revascularization. Transit time flow measurement (TTFM) was used routinely to check graft patency. The purpose of this paper is to report on flowmetry results in the Tuzla CABG population. All patients were considered candidates for both on-pump (ONCAB) and off-pump (OPCAB) CABG procedures. Approximately 60% of the procedures were performed as ONCAB and the rest as OPCAB. For all patients, TTFM was performed on all grafts. Eighteen patients were converted from OPCAB to ONCAB. Revision was required for 1.8% of the grafts. All grafts were successfully revised and were patent at the time of wound closure. We believe that TTFM is a crucial tool in CABG. It offers a reliab...
Medical Archives, 2015
The aortic valve replacement is a standard operating procedure in patients with severe aortic ste... more The aortic valve replacement is a standard operating procedure in patients with severe aortic stenosis. Structure of patients undergoing surgery ranges from young population with isolated mitral valvular disease to the elderly population, which is in addition to the underlying disease additionally burdened with comorbidity. One of the most commonly present factors that further complicate the surgery is coronary heart disease that occurs in, almost, one third of patients with aortic stenosis. The aim is to compare the results of surgery for aortic valve replacement with or without coronary artery bypass graft (CABG). From August 2008 to January 2013 in our center operated on 120 patients for aortic stenosis. Of this number, 75 were men and 45 women. The average age was 63.37 years (16-78). Isolated aortic valve replacement was performed in 89 patients and in 31 patients underwent aortic valve replacement and coronary bypass surgery. Implanted 89 biological and 31 mechanical valves. Patients with associated aortic stenosis and coronary artery disease were more expressed symptomatic symptoms preoperatively to patients with isolated aortic stenosis who were on average younger age. Intra-hospital morbidity and mortality was more pronounced in the group of patients with concomitant aortic valve replacement and coronary bypass surgery. Morbidity was recorded in 17 patients (14.3%) in both groups, while the mortality rate in both groups was 12 patients (10.1%). Evaluation of preoperative risk factors and comorbidity in patients with aortic stenosis and coronary artery disease contributes to a significant reduction in intraoperative and postoperative complications. Also, early diagnosis of associated coronary artery disease and aortic stenosis contributes to timely decision for surgery thus avoiding subsequent ischaemic changes and myocardial damage.
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2009
: The purpose of this randomized study was to evaluate the effect on graft patency by adding clop... more : The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. : Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. : Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. : Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.
Medical Archives, 2013
To report our experience with the retroperitoneal and transperitoneal approaches of laparoscopic ... more To report our experience with the retroperitoneal and transperitoneal approaches of laparoscopic nephrectomy for renal cell carcinoma (RCC). Methods: Between July 2001 and December 2007, 100 patients with RCC underwent laparoscopic radical nephrectomy at our institution for clinically localized RCC. Fifty-three patients received a retroperitoneal procedure and 47 received a transperitoneal procedure. The perioperative and oncological outcomes of these groups were reviewed retrospectively. Results: Mean follow up was 34 months. No statistically significant difference was found between the two approaches in terms of pathological stage, operative time, need for additional procedures such as adrenalectomy and/or lymph node sampling, estimated blood loss, need for blood transfusions, analgesic requirement, length of hospital stay, or the incidence of minor or major complications. The 5-year disease-free survival rate was 90% for both the retroperitoneal and transperitoneal procedures. The 5-year overall survival rates were 98% and 96%, respectively. Therefore, no significant difference was observed in the long-term oncological outcome between the two groups. Conclusions: Tumor control and surgical morbidity in laparoscopic radical nephrectomy seem not to be significantly influenced by the approach.
Medical Archives, 2012
A natomical variations of veins often play a crucial role in formation of thrombotic changes in s... more A natomical variations of veins often play a crucial role in formation of thrombotic changes in superficial and deep veins of lower extremities. The aim of this study was to determine the frequency of the dominant type of the lower extremity superficial veins, and to determine the eventual influence of such variations to the formation of superficial and deep vein thrombosis (DVT). Material and methods: The sample used in this study consisted of 180 patients subjected to ascedent contrast phlebography of lower extremities. The total sample was divided into following groups: patients with and without variations of the lower extremity superficial veins. Results and discussion: Dominant type of the superficial veins (without variation) consisted of 97 patients (53.89%), while the rest of 83 patients showed some kind of anatomical variation (46.11%). The most frequent variation was the duplicated form of v. saphena magna in 53.85%, while this procentage in women was 57.89%. Most frequent variations of duplicated v. saphena magna were: simple duplicated form, closed loop form, branching form and combined form. Topographical variation of saphenopopliteal junction besides fossa poplitea in the group of men showed procentage of 53.85%, while in the group of women that value accounted 63.16%. Conclusion: The percentage of varicose veins was more frequent in men and women without variations, but deep vein DVT showed higher frequency in patients with anatomical variations of superficial veins of lower extremities.
Medical Archives, 2011
W e present a case of 71 year old man operated in our clinic for ruptured abdominal aneurysm comp... more W e present a case of 71 year old man operated in our clinic for ruptured abdominal aneurysm complicated with aorto-caval fistula, which was revealed during the surgery and successfully repaired by direct sutures within the aorta. This is the first record of the aorto-caval fistula that was so far noticed in our clinic. Urgent surgery and repair of the defect conneting aorta and vena cava by direct sutures within the aorta followed by ruptured aneurysm repair with tube graft is only way of treatment. Despite its infrequent occurrence, aorto-caval fistula should always be considered in any case of ruptured abdominal aneurysm.
Medical Archives, 2013
T he number of patients undergoing coronary artery bypass grafting (coronary artery bypass grafti... more T he number of patients undergoing coronary artery bypass grafting (coronary artery bypass grafting-CABG) older than 70 years is increasing. Cardiac surgeons are investigate applicability of alternative and less invasive methods such as surgery without the use of cardiopulmonary bypass (CPB). The aim of this study was to compare the peri-and postoperative results of CABG in elderly patients operated with and without CPB. Patients and Methods: The study included subjects older than 70 years, who underwent coronary bypass surgery at the BH Heart Center Tuzla in the period from August 2008 to August 2010, divided into two groups. Group A consisted of 50 patients operated without CPB, group B 50 patients operated with CPB, adjusted by sex, left ventricular ejection fraction values, EuroSCORE, and the number of bypass grafts was made . Results: In the group treated without the use CPB there were significantly lower values of the time-duration of mechanical ventilation, length of stay in the Intensive Care Unit (ICU), the amount of postoperative bleeding and blood recovered, the length of hospital stay, levels of serum creatinine, C-reactive protein and creatine kinase MB fraction. Conclusion: CABG without the use of CPB has a number of advantages over the method with CPB in elderly patients, which is evident from the lower values of renal and inflammatory parameters and markers of myocardial lesion, less time spent on a ventilator, shorter length of stay in the ICU and total hospitalization time, less postoperative bleeding and blood transfusion.
Medical Archives, 2014
Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wa... more Left ventricular pseudoaneurysm is a rare condition because in most instances ventricular free-wall rupture leads to fatal pericardial tamponade. Rupture of the free wall of the left ventricle is a catastrophic complication of myocardial infarction, occurring in approximately 4% of patients with infarcts, resulting in immediate collapse of the patient and electromechanical dissociation. In rare cases the rupture is contained by pericardial and fibrous tissue, and the result is a pseudoaneurysm. The left ventricular pseudoaneurysm contains only pericardial and fibrous elements in its wall-no myocardial tissue. Because such aneurysms have a strong tendency to rupture, this disorder may lead to death if it is left surgically untreated. In this case report, we present a patient who underwent successful repair of a left ventricular pseudoaneurysm, which followed a myocardial infarction that was caused by occlusion of the left circumflex coronary artery. Although repair of left ventricular pseudoaneurysm is still a surgical challenge, it can be performed with acceptable results in most patients.
Minimally Invasive Therapy & Allied Technologies, 2011
The present article will review new technology in the invasive approach to mitral valvular diseas... more The present article will review new technology in the invasive approach to mitral valvular disease. Mitral valve pathology continues to present an important challenge to the cardiac surgeon and interventionalist. From the early days of closed mitral valvular commisurotomy, a number of new approaches to this valve have been developed. Mitral stenosis was previously approached through a minimally invasive beating heart surgical approach, but may now be treated with either catheter-based or open surgical techniques. Regurgitation, which has become the leading pathology of the mitral valve in the developed world, may be approached through traditional cardiac surgery or through catheter-based techniques. New imaging techniques and device innovation will cause drastic changes in therapy for mitral valvular disease in the foreseeable future.
Journal of Thoracic and Cardiovascular Surgery, 2004
The objective of this study was to investigate the patency in saphenous vein coronary bypass graf... more The objective of this study was to investigate the patency in saphenous vein coronary bypass grafts in which the proximal anastomoses were performed with automatic connector devices or with a traditional suture technique.
Heart, Lung and Circulation, 2010
We have previously demonstrated that transittime flow measurements (TTFM) reliably predict the ne... more We have previously demonstrated that transittime flow measurements (TTFM) reliably predict the need for revision of coronary grafts during off-pump coronary artery bypass grafting (OPCAB). The present study tested whether TTFM may predict graft patency at three months.
Heart, Lung and Circulation, 2007
ABSTRACT
The Annals of Thoracic Surgery, 2007
Background. Bosnia and Herzegovina did not have invasive cardiac diagnosis or cardiac surgery bef... more Background. Bosnia and Herzegovina did not have invasive cardiac diagnosis or cardiac surgery before the recent war. With assistance from the United States and Norway, a cardiovascular clinic was developed. This study reports center-specific and surgeon-specific clinical outcomes. Since off-pump coronary bypass grafting surgery was prioritized in the treatment of coronary disease, a comparison was made between operations performed with and without cardiopulmonary bypass.