Jacob Bergsland - Academia.edu (original) (raw)
Papers by Jacob Bergsland
Circulation, Nov 22, 2011
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, Jan 23, 2015
The first interventional attempts at relieving mitral valve disease were in a sense minimally inv... more The first interventional attempts at relieving mitral valve disease were in a sense minimally invasive, using relatively small incisions and introduction of instruments or a finger to open stenotic valves on the beating heart. The development of reliable cardiopulmonary bypass (CPB) made exact anatomic repair of mitral pathology possible with improved results. Mitral valve surgery on an arrested heart has been the mainstay of treatment for decades. Modifications and minimalization of the surgical approach using videoscopic or robotic instruments have made less invasive procedures possible. Such procedures demand excellent technical skills and are still not widely adopted. More recently, attempts have been made to repair mitral valves using endovascular access on the beating heart, guiding the repair process with real-time imaging. We are presenting a review of available and developing techniques for endovascular repair of the mitral valve. A device developed by our group will be bri...
British journal of anaesthesia, 2015
Coronary stenosis after coronary artery bypass grafting (CABG) may lead to myocardial ischaemia a... more Coronary stenosis after coronary artery bypass grafting (CABG) may lead to myocardial ischaemia and is clinically difficult to diagnose. In a CABG model, we aimed at defining variables that detect hypoperfusion in real-time and correlate with impaired regional ventricular function by monitoring myocardial tissue metabolism. Off-pump CABG was performed in 10 pigs. Graft blood flow was reduced in 18 min intervals to 75, 50, and 25% of baseline flow with reperfusion between each flow reduction. Myocardial tissue Pco2 ([Formula: see text]), Po2, pH, glucose, lactate, and glycerol from the graft supplied region and a control region were obtained. Regional cardiac function was assessed as radial strain. In comparison with baseline, myocardial pH decreased during 75, 50, and 25% flow reduction (-0.15; -0.22; -0.37, respectively, all P<0.05) whereas [Formula: see text] increased (+4.6 kPa; +7.8 kPa; +12.9 kPa, respectively, all P<0.05). pH and [Formula: see text] returned to baseline ...
Medicinski arhiv, 2007
Patients with significant stenosis (>50%) of the left main coronary artery (LM) are considered... more Patients with significant stenosis (>50%) of the left main coronary artery (LM) are considered high risk for coronary artery bypass grafting (CABG). LM disease is mainly considered a relative contraindication for off pump coronary artery bypass grafting (OPCAB) because of the reduced tolerancy of hamodynamic disturbances which occurs during mobilisation and exposition of the heart, necessary for this type of operations. The aim of the study is to show feasibility of OPCAB for patient with occlusion of the LM and 75% stenosis of the right coronary artery. Operation was carried out through median sternotomy, LIMA stitch was used for the exposure, CTS stabilisator was used for local myocardial stabilisation, intracoronary shunt was inserted intraluminary. Three aortocoronary bypasses were created, operation passed without any hamodynamic instability. Main peri and postoperative results: total length of the operation: 265 min; time on respirator: 1 hour; total blood drainage on chest...
Medicinski arhiv, 2011
Dextrocardia is a condition in which the heart is pointed toward the right side of the chest inst... more Dextrocardia is a condition in which the heart is pointed toward the right side of the chest instead of normally pointing to the left. The rate of atherosclerotic heart disease in subjects with this condition is similar to that of the general population. We present a patient with situs inversus totalis with dextrocardia who underwent coronary artery bypass grafting without use of cardiopulmonary bypass (OPCAB). A 74-year-old man who was known to have dextrocardia with situs inversus was admitted to the hospital because of angina. Coronary angiography was performed and showed ostial occlusion of the left anterior descendng artery (LAD) unsuitable for percutaneous coronary interventions but collatereralised from the right coronary artery. Patient underwent OPCAB under general anestesia. Right internal mammary artery was anastomosed to LAD on the beating heart with the surgeon standing on the right side of the patient. The patient's post-operative course was uneventful, and he was ...
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 ...
![Research paper thumbnail of Management [corrected] of conversions to cardiopulmonary bypass in beating heart coronary surgery](https://attachments.academia-assets.com/100338215/thumbnails/1.jpg)
](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, 2006
The issue of the quality of bypass grafts, which appeared to be a key fact in the coronary artery... more The issue of the quality of bypass grafts, which appeared to be a key fact in the coronary artery bypass grafting (CABG), was raised with the popularization of the operations performed without the use of cardiopulmonary bypass (CPB). Among handful methods used in the past that were abundant in defects, Transit time flow measurement (TTFM) has recently stood out for its good features. The objective of the paper is: to compare main peri and postoperative results of operations with and without CPB; to establish total number of the bypass grafts revised on the basis of TTFM results in both groups of the examinees; to evaluate sensitivity, specificity, predictive rate and accuracy of TTFM with regards to the intraoperative coronary angiography (golden standard). Study was done in the period between 01.07.2002 and 30.06.2004 in two centers. In the Cardiovascular Clinic, University Clinical Centre Tuzla, 150 examinees were operated on without the use of CPB (group A) and compared with 150 ...
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, 2005
There have been 784 coronary artery bypass grafting (CABG) procedures performed at a new center f... more There have been 784 coronary artery bypass grafting (CABG) procedures performed at a new center for treating cardiovascular disease in Tuzla, Bosnia and Herzegovina, and the surgical team has been fully trained in offpump coronary artery bypass (OPCAB) surgery. All surgical patients were considered for on-pump CABG (ONCAB) and OPCAB surgical procedures. Minimally invasive direct coronary artery bypass grafting and robotic procedures were done as OPCAB. For multivessel median sternotomy cases, the selection criteria were arbitrary (approximately 50% were performed as ONCAB for perfusionist training). Patients who were scheduled for and began their operations as OPCAB but who were then placed on cardiopulmonary bypass during the surgical procedure were counted as conversions. The outcomes of converted patients were studied and are the subject of this report. Of the 784 CABG procedures, 391 (49.6%) were scheduled and performed as ONCAB operations; 357 (45.5%) were performed as OPCAB; and 36 (9.2% of the originally scheduled OPCAB patients or 4.6% of the total number of CABG surgeries) were originally scheduled as OPCAB operations but were converted to ONCAB. Reasons for conversions were hemodynamic instability (21 patients), difficult revision of grafts (8), ventricular fibrillation (5), and poor native vessel (2). Outcomes of patients undergoing conversions were analyzed with respect to the conversion cause. When the cause of the conversion was mild-to-moderate hemodynamic instability or difficult graft revision (n = 27), no adverse ischemic effects were seen; however, when the cause of conversion was severe hemodynamic instability, ventricular fibrillation, or cardiac arrest (n = 9), 6 patients (66.6%) had severe ischemic complications involving the central nervous system or the myocardium. Myocardial ischemia must be monitored and treated aggressively in OPCAB surgery. In patients with mild hemodynamic instability, conversion did not adversely affect outcome. In patients with severe hemodynamic compromise and cardiac arrest, serious complications of cerebral and myocardial ischemia were observed. The appropriate timing of conversion is essential.
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 the American College of Cardiology, 2010
Introduction. Hypothermia is used for neuroprotection in patients after cardiac arrest. However, ... more Introduction. Hypothermia is used for neuroprotection in patients after cardiac arrest. However, therapeutic hypothermia at 33º C also affects myocardial function. To elucidate these effects we studied myocardial function during hypothermia in a porcine model, with particular emphasis on diastolic dysfunction. Methods: 8 anesthetized open chest pigs were cooled from baseline (38º C) to hypothermia (33º C). With a micromanometer in the left ventricle (LV), peak systolic (LVP) and end-diastolic pressure (EDP) was measured, and LV dP/dt was calculated. Systolic duration was measured from R on ECG to dP/dtmin, and isovolumic relaxation time (IVRt) from dP/dtmin to mitral valve opening. Time constant of LV relaxation (τ) was calculated in IVRt. Transmitral flow velocities (early diastolic flow = E; atrial flow = A) were measured by 2D echo/Doppler. Measurements were made at 38º and 33º C, and results are given as mean±SD. Comparisons were made by paired t-test, p≤0.05 was considered significant. Results: Heart rate decreased from 38º to 33º C, 93±11 to 80±11 beats per minute (p<0.05). LVP decreased (78±6 to 70±12 mmHg, p<0.05), while EDP did not change. Systolic duration increased at 33º C (0.33±0.02 to 0.46±0.04 s, p<0.05), while diastolic duration decreased (0.30±0.06 to 0.27±0.09 s, p<0.05). IVRt was also prolonged at 33º (0.04±0.01 to 0.07±0.02 s, p<0.05), resulting in a decreased filling time (0.28±0.06 to 0.24±0.09 s, p<0.05). τ increased from 31±6 to 61±10 ms (p<0.05). E decreased from 0.7±0.1 to 0.5±0.2 cm/s (p<0.05), while A did not change significantly (0.5±0.1 to 0.6±0.1 cm/s). The resulting E/A ratio changed from 1.2±0.2 to 0.9±0.3 (p<0.05). Conclusion: The prolongation of systolic duration and IVRt resulted in a significantly decreased LV diastolic filling time. Together with the slowed relaxation this may alter the diastolic properties. The reduced amplitude in early diastolic transmitral flow (E) and the inversion of E/A ratio during hypothermia support this assumption, and suggest a compromised LV filling more dependent on atrial contribution.
Heart, Lung and Circulation, 2010
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. Methods. Surgeons and key staff members were trained in the United States. A Norwegian data management system for cardiac surgery was implemented and cases entered after quality review of the data. A total of 1276 patients were entered; operations were performed with cardiopulmonary bypass in 540 and without in 736. The primary surgeon was entered as a variable in an anonymous fashion. Results. Overall mortality for coronary bypass grafting surgery was 1.6%, and the major complication rate was 4.5%. Patients operated on off-pump received fewer grafts and had a shorter length of stay. Unfavorable outcome was more common in patients when cardiopulmonary bypass was used in the operation. Regression analysis demonstrated that the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and use of cardiopulmonary bypass were predictors of poor outcome. The individual surgeon factor did not impact on outcomes. Conclusions. Our study confirms that coronary artery bypass grafting surgery may be performed safely in a poor country in a hospital without experience with cardiac surgery. Selection of talented staff and cooperation with international cardiac centers are crucial. Off-pump coronary artery bypass grafting surgery is suitable for a new center and does not require more training than standard procedures.
… and Techniques in …, 2009
Wolters Kluwer Health may email you for journal alerts and information, but is committed to maint... more Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent. For more information, please refer to our Privacy Policy. ... Skip Navigation Links Home > ...
Circulation, Nov 22, 2011
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, Jan 23, 2015
The first interventional attempts at relieving mitral valve disease were in a sense minimally inv... more The first interventional attempts at relieving mitral valve disease were in a sense minimally invasive, using relatively small incisions and introduction of instruments or a finger to open stenotic valves on the beating heart. The development of reliable cardiopulmonary bypass (CPB) made exact anatomic repair of mitral pathology possible with improved results. Mitral valve surgery on an arrested heart has been the mainstay of treatment for decades. Modifications and minimalization of the surgical approach using videoscopic or robotic instruments have made less invasive procedures possible. Such procedures demand excellent technical skills and are still not widely adopted. More recently, attempts have been made to repair mitral valves using endovascular access on the beating heart, guiding the repair process with real-time imaging. We are presenting a review of available and developing techniques for endovascular repair of the mitral valve. A device developed by our group will be bri...
British journal of anaesthesia, 2015
Coronary stenosis after coronary artery bypass grafting (CABG) may lead to myocardial ischaemia a... more Coronary stenosis after coronary artery bypass grafting (CABG) may lead to myocardial ischaemia and is clinically difficult to diagnose. In a CABG model, we aimed at defining variables that detect hypoperfusion in real-time and correlate with impaired regional ventricular function by monitoring myocardial tissue metabolism. Off-pump CABG was performed in 10 pigs. Graft blood flow was reduced in 18 min intervals to 75, 50, and 25% of baseline flow with reperfusion between each flow reduction. Myocardial tissue Pco2 ([Formula: see text]), Po2, pH, glucose, lactate, and glycerol from the graft supplied region and a control region were obtained. Regional cardiac function was assessed as radial strain. In comparison with baseline, myocardial pH decreased during 75, 50, and 25% flow reduction (-0.15; -0.22; -0.37, respectively, all P<0.05) whereas [Formula: see text] increased (+4.6 kPa; +7.8 kPa; +12.9 kPa, respectively, all P<0.05). pH and [Formula: see text] returned to baseline ...
Medicinski arhiv, 2007
Patients with significant stenosis (>50%) of the left main coronary artery (LM) are considered... more Patients with significant stenosis (>50%) of the left main coronary artery (LM) are considered high risk for coronary artery bypass grafting (CABG). LM disease is mainly considered a relative contraindication for off pump coronary artery bypass grafting (OPCAB) because of the reduced tolerancy of hamodynamic disturbances which occurs during mobilisation and exposition of the heart, necessary for this type of operations. The aim of the study is to show feasibility of OPCAB for patient with occlusion of the LM and 75% stenosis of the right coronary artery. Operation was carried out through median sternotomy, LIMA stitch was used for the exposure, CTS stabilisator was used for local myocardial stabilisation, intracoronary shunt was inserted intraluminary. Three aortocoronary bypasses were created, operation passed without any hamodynamic instability. Main peri and postoperative results: total length of the operation: 265 min; time on respirator: 1 hour; total blood drainage on chest...
Medicinski arhiv, 2011
Dextrocardia is a condition in which the heart is pointed toward the right side of the chest inst... more Dextrocardia is a condition in which the heart is pointed toward the right side of the chest instead of normally pointing to the left. The rate of atherosclerotic heart disease in subjects with this condition is similar to that of the general population. We present a patient with situs inversus totalis with dextrocardia who underwent coronary artery bypass grafting without use of cardiopulmonary bypass (OPCAB). A 74-year-old man who was known to have dextrocardia with situs inversus was admitted to the hospital because of angina. Coronary angiography was performed and showed ostial occlusion of the left anterior descendng artery (LAD) unsuitable for percutaneous coronary interventions but collatereralised from the right coronary artery. Patient underwent OPCAB under general anestesia. Right internal mammary artery was anastomosed to LAD on the beating heart with the surgeon standing on the right side of the patient. The patient's post-operative course was uneventful, and he was ...
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, 2006
The issue of the quality of bypass grafts, which appeared to be a key fact in the coronary artery... more The issue of the quality of bypass grafts, which appeared to be a key fact in the coronary artery bypass grafting (CABG), was raised with the popularization of the operations performed without the use of cardiopulmonary bypass (CPB). Among handful methods used in the past that were abundant in defects, Transit time flow measurement (TTFM) has recently stood out for its good features. The objective of the paper is: to compare main peri and postoperative results of operations with and without CPB; to establish total number of the bypass grafts revised on the basis of TTFM results in both groups of the examinees; to evaluate sensitivity, specificity, predictive rate and accuracy of TTFM with regards to the intraoperative coronary angiography (golden standard). Study was done in the period between 01.07.2002 and 30.06.2004 in two centers. In the Cardiovascular Clinic, University Clinical Centre Tuzla, 150 examinees were operated on without the use of CPB (group A) and compared with 150 ...
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, 2005
There have been 784 coronary artery bypass grafting (CABG) procedures performed at a new center f... more There have been 784 coronary artery bypass grafting (CABG) procedures performed at a new center for treating cardiovascular disease in Tuzla, Bosnia and Herzegovina, and the surgical team has been fully trained in offpump coronary artery bypass (OPCAB) surgery. All surgical patients were considered for on-pump CABG (ONCAB) and OPCAB surgical procedures. Minimally invasive direct coronary artery bypass grafting and robotic procedures were done as OPCAB. For multivessel median sternotomy cases, the selection criteria were arbitrary (approximately 50% were performed as ONCAB for perfusionist training). Patients who were scheduled for and began their operations as OPCAB but who were then placed on cardiopulmonary bypass during the surgical procedure were counted as conversions. The outcomes of converted patients were studied and are the subject of this report. Of the 784 CABG procedures, 391 (49.6%) were scheduled and performed as ONCAB operations; 357 (45.5%) were performed as OPCAB; and 36 (9.2% of the originally scheduled OPCAB patients or 4.6% of the total number of CABG surgeries) were originally scheduled as OPCAB operations but were converted to ONCAB. Reasons for conversions were hemodynamic instability (21 patients), difficult revision of grafts (8), ventricular fibrillation (5), and poor native vessel (2). Outcomes of patients undergoing conversions were analyzed with respect to the conversion cause. When the cause of the conversion was mild-to-moderate hemodynamic instability or difficult graft revision (n = 27), no adverse ischemic effects were seen; however, when the cause of conversion was severe hemodynamic instability, ventricular fibrillation, or cardiac arrest (n = 9), 6 patients (66.6%) had severe ischemic complications involving the central nervous system or the myocardium. Myocardial ischemia must be monitored and treated aggressively in OPCAB surgery. In patients with mild hemodynamic instability, conversion did not adversely affect outcome. In patients with severe hemodynamic compromise and cardiac arrest, serious complications of cerebral and myocardial ischemia were observed. The appropriate timing of conversion is essential.
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 the American College of Cardiology, 2010
Introduction. Hypothermia is used for neuroprotection in patients after cardiac arrest. However, ... more Introduction. Hypothermia is used for neuroprotection in patients after cardiac arrest. However, therapeutic hypothermia at 33º C also affects myocardial function. To elucidate these effects we studied myocardial function during hypothermia in a porcine model, with particular emphasis on diastolic dysfunction. Methods: 8 anesthetized open chest pigs were cooled from baseline (38º C) to hypothermia (33º C). With a micromanometer in the left ventricle (LV), peak systolic (LVP) and end-diastolic pressure (EDP) was measured, and LV dP/dt was calculated. Systolic duration was measured from R on ECG to dP/dtmin, and isovolumic relaxation time (IVRt) from dP/dtmin to mitral valve opening. Time constant of LV relaxation (τ) was calculated in IVRt. Transmitral flow velocities (early diastolic flow = E; atrial flow = A) were measured by 2D echo/Doppler. Measurements were made at 38º and 33º C, and results are given as mean±SD. Comparisons were made by paired t-test, p≤0.05 was considered significant. Results: Heart rate decreased from 38º to 33º C, 93±11 to 80±11 beats per minute (p<0.05). LVP decreased (78±6 to 70±12 mmHg, p<0.05), while EDP did not change. Systolic duration increased at 33º C (0.33±0.02 to 0.46±0.04 s, p<0.05), while diastolic duration decreased (0.30±0.06 to 0.27±0.09 s, p<0.05). IVRt was also prolonged at 33º (0.04±0.01 to 0.07±0.02 s, p<0.05), resulting in a decreased filling time (0.28±0.06 to 0.24±0.09 s, p<0.05). τ increased from 31±6 to 61±10 ms (p<0.05). E decreased from 0.7±0.1 to 0.5±0.2 cm/s (p<0.05), while A did not change significantly (0.5±0.1 to 0.6±0.1 cm/s). The resulting E/A ratio changed from 1.2±0.2 to 0.9±0.3 (p<0.05). Conclusion: The prolongation of systolic duration and IVRt resulted in a significantly decreased LV diastolic filling time. Together with the slowed relaxation this may alter the diastolic properties. The reduced amplitude in early diastolic transmitral flow (E) and the inversion of E/A ratio during hypothermia support this assumption, and suggest a compromised LV filling more dependent on atrial contribution.
Heart, Lung and Circulation, 2010
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. Methods. Surgeons and key staff members were trained in the United States. A Norwegian data management system for cardiac surgery was implemented and cases entered after quality review of the data. A total of 1276 patients were entered; operations were performed with cardiopulmonary bypass in 540 and without in 736. The primary surgeon was entered as a variable in an anonymous fashion. Results. Overall mortality for coronary bypass grafting surgery was 1.6%, and the major complication rate was 4.5%. Patients operated on off-pump received fewer grafts and had a shorter length of stay. Unfavorable outcome was more common in patients when cardiopulmonary bypass was used in the operation. Regression analysis demonstrated that the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and use of cardiopulmonary bypass were predictors of poor outcome. The individual surgeon factor did not impact on outcomes. Conclusions. Our study confirms that coronary artery bypass grafting surgery may be performed safely in a poor country in a hospital without experience with cardiac surgery. Selection of talented staff and cooperation with international cardiac centers are crucial. Off-pump coronary artery bypass grafting surgery is suitable for a new center and does not require more training than standard procedures.
… and Techniques in …, 2009
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