Payvand Bina - Academia.edu (original) (raw)

Papers by Payvand Bina

Research paper thumbnail of Transseptal Approach versus Left Atrial Approach to Mitral Valve: A Propensity Score Matching Study

PubMed, Oct 27, 2015

Background: Many patients with mitral valve diseases need surgical procedures for the repair or r... more Background: Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching. Methods: This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI). Results: The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274). Conclusion: In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.

Research paper thumbnail of Randomized Trial of Carnitine for the Prevention of Perioperative Atrial Fibrillation

Seminars in Thoracic and Cardiovascular Surgery, 2018

Atrial fibrillation (AF) is one of the most common complications in patients who undergo coronary... more Atrial fibrillation (AF) is one of the most common complications in patients who undergo coronary artery bypass graft surgery (CABG). The aim of this study was to evaluate the effect of L-carnitine administration on postoperative AF and the levels of C-reactive protein (CRP) following CABG. The effects of L-carnitine on the incidence of acute kidney injury after CABG were also assessed. One hundred thirty-four patients undergoing elective CABG, without a history of AF or previous L-carnitine treatment, were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or a control group. CRP levels, as a biomarker of inflammation, were assessed in all the patients before surgery as baseline levels and 48 hours postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney biomarker, was also measured in the patients before surgery and 2 hours thereafter. The incidence of AF was 13.4% in our population. The incidence of AF was decreased in the L-carnitine group (7.5% in the L-carnitine group vs 19.4% in the control group; P = 0.043) and the postoperative CRP level (8.79 ± 6.9 in the L-carnitine group, and 10.83 ± 5.7 in the control group; P = 0.021). The postoperative neutrophil gelatinase-associated lipocalin concentration demonstrated no significant rise after surgery compared with the preoperative concentration (72.54 ± 20.30 in the L-carnitine group vs 67.68 ± 22.71 in the placebo group; P = 0.19). Our study showed that L-carnitine administration before CABG might inhibit and reduce the incidence of AF after CABG. It seems that a rise in the CRP level, as an inflammation marker, may be associated with the incidence of AF. Inflammation as measured by CRP was also reduced in the carnitine group, compared with the control group.

Research paper thumbnail of Utility of the CHA2DS2-VASc Score in Prediction of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2022

OBJECTIVE The authors aimed to investigate the role of CHA2DS2-VASc score and its components in p... more OBJECTIVE The authors aimed to investigate the role of CHA2DS2-VASc score and its components in prediction of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery. DESIGN Retrospective cohort. SETTING Single-center university-affiliated tertiary cardiac center. PARTICIPANTS A total of 2,981 consecutive patients who underwent isolated CABG between 2010 and 2012 were included. INTERVENTIONS All patients underwent isolated CABG and were followed until discharge or in-hospital death. The primary outcome was the development of new-onset POAF during the hospital course. MEASUREMENTS AND MAIN RESULTS During hospitalization, continuous electrocardiogram monitoring was used to detect POAF episodes. New-onset POAF developed in 15.8% of patients following isolated CABG. Patients with POAF had significantly higher CHA2DS2-VASc scores than those without POAF (2.66 ± 1.51 v 2.12 ± 1.36, p < 0.001). After adjustment for potential confounders, CHA2DS2-VASc score was significantly associated with POAF (odds ratio [OR]: 1.295, 95% CI: 1.205-1.391). However, further analyses showed that this effect was restricted to patients with a CHA2DS2-VASc score of ≥2 (OR: 1.813, 95% CI: 1.220-2.694). In multivariate analysis of the CHA2DS2-VASc components, age ≥75 (OR: 3.737, 95% CI: 2.702-5.168), age 65 to 74 (OR: 2.126, 1.701-2.658), hypertension (OR: 1.310, 95% CI: 1.051-1.633), and cerebrovascular accident (OR: 1.807, 95% CI: 1.197-2.726) were independent predictors of POAF. However, the association between POAF and female sex, diabetes mellitus, congestive heart failure, and vascular disease was not statistically significant. CONCLUSIONS CHA2DS2-VASc score is a useful tool for the prediction of POAF after isolated CABG. However, the risk should be interpreted cautiously, since the risk score's promising effect relies on only several of its components.

Research paper thumbnail of Role of Ventral Hippocampal GABA<sub>A</sub> and NMDA Receptors in the Anxiolytic Effect of Carbamazepine in Rats Using the Elevated Plus Maze Test

Pharmacology, 2009

Background: The successful use of antiepileptic drugs to treat a wide range of nonepileptic disor... more Background: The successful use of antiepileptic drugs to treat a wide range of nonepileptic disorders led us to evaluate the potential efficacy of carbamazepine (CBZ) in anxiety disorders. Anxiety may be related to the imbalance between γ-aminobutyric acid (GABA) and glutamate neurotransmitters, systems that are also involved in the CBZ effects. We investigated the role of these systems in the ventral hippocampus (VH) and their interactions with the CBZ effect on anxiety-like behavior in rats using the elevated plus maze. Methods: Animals received GABAergic and NMDA agents in a volume of 1 μl/rat, which was injected into the VH (0.5 μl for each side) 60 min after receiving systemic administration of CBZ. The test sessions took place 10 min later. Results: The systemic administration of CBZ increased the percentage of open arm time (%OAT) at the dose of 40 mg/kg, which is representative of an anxiolytic response. Intra-VH injection of the GABAA receptor agonist muscimol (0.25–1 μg/rat) in the absence or presence of an ineffective dose of CBZ (30 mg/kg) did not show any significant changes in the parameters of anxiety-like behavior. The administration of GABAA receptor antagonist bicuculline by itself decreased %OAT at a dose of 1 μg/rat, indicating possible anxiogenic effect. The antagonist (0.75 and 1 μg/rat) also decreased CBZ response. A microinjection of NMDA (0.125 and 0.25 μg/rat) decreased %OAT, which was reversed by the administration of CBZ (40 mg/kg). This indicates interaction between the two drugs. However, the NMDA receptor antagonist DAP-5 (1 μg/rat) significantly increased %OAT, but combined with the lower dose of CBZ (30 mg/kg), it did not trigger any response on anxiety-like parameters. Conclusion: Both GABAergic and NMDA systems in the VH play a role in modulation of anxiety-like behavior of rats. The anxiolytic-like effects of CBZ seem to be mediated, at least in part, through an interaction with GABAA and NMDA systems in the VH.

Research paper thumbnail of Ascending Aorta Aneurysm and Blood Group A among Iranian Patients

Thrombosis Research, Feb 1, 2013

Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demo... more Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demonstrating risk factors for this disease is essential for development of screening strategies for high-risk populations. Blood group although described as a potential risk factor for abdominal aortic aneurysm, has not been addressed in patients with aneurysm of the ascending aorta. Our study aimed to demonstrate the prevalence of ABO blood groups among one of the largest Iranian population with diagnosed aneurysm of the ascending aorta. A retrospective study was conducted in Tehran Heart Center in Tehran, Iran reviewing profile of 24,433 patients admitted to the cardiac surgery ward between January 2005 and February 2012 to extract data of 96 patients with confirmed diagnosis of ascending aortic aneurysm (AAA). Frequency of blood groups was determined and risk factors and AAA-related complications and mortality were compared between different blood groups. Of ninety six patients with AAA, 38 patients (39.58%) had blood group A, followed by 16 patients with blood group B (16.66%), 12 blood group AB (12.5%), and 30 patients (30.25%) with blood group O. Cerebrovascular accident (CVA), peripheral vascular disease (PVD), and AAA-related mortality were more frequent in patients with blood group A. However, it did not reveal statistically significant difference (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Our study showed that risk factors for developing vascular disease are more prevalent in patients with blood group A and this blood group is associated with higher complication and mortality in AAA.

Research paper thumbnail of Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Critical pathways in cardiology, Mar 1, 2017

Background: We investigated the association of the preoperative hemoglobin a1c (Hba1c) with occur... more Background: We investigated the association of the preoperative hemoglobin a1c (Hba1c) with occurrence of postoperative atrial fibrillation (POaF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. Methods: We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. all patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. the role of Hba1c as a predictor for the occurrence of atrial fibrillation was then evaluated. Results: a total of 109 (15.3%) patients developed POaF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. in the univariable and multivariable regression model, Hba1c was not a predictor for POaF. Conclusions: Serum level of Hba1c could not be used as a predictor for the development of POaF.

Research paper thumbnail of Distribution of ABO Blood Groups among Patients with Congenital Heart Defects

Journal of Pioneering Medical Sciences, Jun 1, 2016

Background: Although an association between congenital heart disease (CHD) and ABO blood group ty... more Background: Although an association between congenital heart disease (CHD) and ABO blood group types have been proposed, this relationship has not been well-established. The purpose of this study was to determine the distribution of different ABO blood groups according to CHD sub-types in a large population of patients undergoing surgical repair for CHD. Methods: In a retrospective review of hospital data registry, medical profiles of 34,239 admitted patients between January 2003 and December 2012 were reviewed to identify cases with CHD who had undergone surgical repair. CHD types, ABO blood groups and clinical and final outcomes were recorded. Results: Data from 1,155 patients were analyzed. We did not find an association of a blood group type and a particular CHD type. Similarly, we did not find an association between blood group types and outcomes. Conclusion: We did not find an association between blood group type and type of CHD or outcomes after CHD correction.

Research paper thumbnail of The effect of paroxetine on ouabain-induced toxicity in isolated guinea pig atria

PubMed, 2011

It has been reported that selective serotonin reuptake inhibitors (SSRIs) possess some cardiac ef... more It has been reported that selective serotonin reuptake inhibitors (SSRIs) possess some cardiac effects. In the present study we have investigated the effect of paroxetine (PX), a potent SSRI agent, on spontaneously as well as ouabain-induced arrhythmia beating isolated guinea-pig atria. The Guinea-pig heart was rapidly removed; the auricles were dissected out in oxygenated modified Krebs solution. The rate and force of spontaneous contractions were recorded isometrically with a photosensitive transducer. PX (1-16 µg/ml) caused a dose-dependent decrease in the rate of contractions (14-70%) and contractile force (8-16%). Ouabain alone (1.2 µg/ml) produced arrhythmia at 7.2 ± 1.5 min and asystole at 20.1 ± 3.1 min. Pretreatment with PX (4 µg/ml) significantly increased the time of arrhythmia onset to 19.8 min. In addition, PX prolonged the duration of action beating from 20.1 ± 3.1 min to 43.1± 2.6 and delayed the occurrence of asystole. The pattern of contractile force by PX + ouabain treatment was more regular than that observed after administration of ouabain alone. The above findings may the probably be due to the inhibition of cardiac Na(+) and Ca(2+) channels or autonomic nervous system. Results also suggest that PX may reduce the membrane conductance through inhibition of ionic channels to prevent ouabain-induced arrhythmia.

Research paper thumbnail of Knowledge management in cardiac surgery: the second tehran heart center adult cardiac surgery database report

The journal of Tehran Heart Center, 2012

The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a v... more The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. There were 24959 procedures performed: 19663 (78.8%) isolated coronary artery bypass grafting surgeries (CABGs); 1492 (6.0%) isolated valve surgeries; 1437 (5.8%) CABGs concomitant with other procedures; 832 (3.3%) CABGs combined with valve surgeries; 722 (2.9%) valve surgeries concomitant with other procedures; 545 (2.2%) surgeries other than ...

Research paper thumbnail of Anxiety-like behavior induced by histaminergic agents can be prevented by cannabinoidergic WIN55,212-2 injected into the dorsal hippocampus in mice

Pharmacology, Biochemistry and Behavior, 2010

In the present study, we investigate the effects of the histaminergic system and cannabinoid rece... more In the present study, we investigate the effects of the histaminergic system and cannabinoid receptor agents on anxiety-related behaviors and their interactions using the hole-board test on mice. Bilateral intra-CA1 administration of the CB1/CB2 receptor agonist, WIN55, 212-2 (0.1-0.5microg/mouse) did not modify exploratory behaviors in mice. On the other hand, intra-CA1 administration of CB1 receptor antagonist, AM251 (25 and 50ng/mouse) or histamine, pyrilamine and ranitidine (5-10microg/mouse) decreased the amount of head-dipping and increased the first head-dip, suggesting an anxiogenic-like response. Furthermore, our present data indicated that the co-administration of WIN55, 212-2 (0.25microg/mouse) with histaminergic agents, decreased the anxiogenic-like response of an effective dose (5microg/mouse) of histamine and pyrilamine, but not that of ranitidine. In addition, the results demonstrated that co-administration of an ineffective dose of AM251 (15ng/mouse) with histaminergic drugs did not alter the response induced by an ineffective dose (3.75microg/mouse) of either histamine or pyrilamine and ranitidine. In all experiments and doses, locomotor activity and other exploratory behaviors were not significantly changed. In conclusion, our results showed that there is a chance of partial interaction between the cannabinoidergic and the histaminergic systems of the dorsal hippocampus on anxiogenic/anxiolytic-like behaviors in hole-board test.

Research paper thumbnail of Surgical management of Sternal wound infection post cardiac surgery "single surgeon experience

Journal of Cardiothoracic Surgery, 2015

Sternal osteomyelitis and post sternotomy mediastinitis still stays as a severe life-threatening ... more Sternal osteomyelitis and post sternotomy mediastinitis still stays as a severe life-threatening complication after cardiac surgery. This study was conducted to evaluate the short and long term results of surgical management of deep sternal wounds infection (DSWI).

Research paper thumbnail of Distribution of ABO Blood Groups among Patients with Congenital Heart Defects

Journal of Pioneering Medical Sciences, 2016

Background: Although an association between congenital heart disease (CHD) and ABO blood group ty... more Background: Although an association between congenital heart disease (CHD) and ABO blood group types have been proposed, this relationship has not been well-established. The purpose of this study was to determine the distribution of different ABO blood groups according to CHD sub-types in a large population of patients undergoing surgical repair for CHD. Methods: In a retrospective review of hospital data registry, medical profiles of 34,239 admitted patients between January 2003 and December 2012 were reviewed to identify cases with CHD who had undergone surgical repair. CHD types, ABO blood groups and clinical and final outcomes were recorded. Results: Data from 1,155 patients were analyzed. We did not find an association of a blood group type and a particular CHD type. Similarly, we did not find an association between blood group types and outcomes. Conclusion: We did not find an association between blood group type and type of CHD or outcomes after CHD correction.

Research paper thumbnail of Anxiolytic-Like Effects and Increase in Locomotor Activity Induced by Infusions of NMDA into the Ventral Hippocampus in Rat: Interaction with GABAergic System

Basic and Clinical Neuroscience, 2014

Introduction: In this study, we investigated the role of N-Methyl-D-Aspartate (NMDA) receptors in... more Introduction: In this study, we investigated the role of N-Methyl-D-Aspartate (NMDA) receptors in the ventral hippocampus (VH) and their possible interactions with GABAA system on anxiety-like behaviors. Methods: We used an elevated-plus maze test (EPM) to assess anxiety-like behaviors and locomotor activity in male Wistar rats. Results: The results showed that intra-VH infusions of different doses of NMDA (0.25 and 0.5 μg/rat) increased locomotor activity, and also induced anxiolytic-like behaviors, as revealed by a tendency to increase percentage of open arm time (%OAT), and a significant increase in percentage of open arm entries (%OAE). The results also showed that intra-VH infusions of muscimol (0.5 and 1 μg/rat) or bicuculline (0.5 and 1 μg/rat) did not significantly affect anxiety-like behaviors, but bicuculline at dose of 1 μg/rat increased locomotor activity. Intra-VH co-infusions of muscimol (0.5 μg/rat) along with low doses of NMDA (0.0625 and 0.125 μg/rat) showed a tende...

Research paper thumbnail of Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Mortality of Coronary Artery Bypass Grafting

Background There is controversy over the potential benefits/harms of the usage of angiotensin-con... more Background There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as regards the postoperative mortality of coronary artery bypass grafting (CABG). This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Methods Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 (46.38%) patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. Results The mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. Eighty-seven (0.86%) patients expired within 30 days. Multivariate analysis...

Research paper thumbnail of Randomized Trial of Carnitine for the Prevention of Perioperative Atrial Fibrillation

Seminars in Thoracic and Cardiovascular Surgery

Research paper thumbnail of Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Critical pathways in cardiology, Mar 1, 2017

We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of pos... more We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated. A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF. Serum level of HbA1c could not be used as a predictor for the development of...

Research paper thumbnail of Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Critical pathways in cardiology, Mar 1, 2017

We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of pos... more We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated. A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF. Serum level of HbA1c could not be used as a predictor for the development of...

Research paper thumbnail of Ascending Aorta Aneurysm and Blood Group A among Iranian Patients

Thrombosis Research, 2013

Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demo... more Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demonstrating risk factors for this disease is essential for development of screening strategies for high-risk populations. Blood group although described as a potential risk factor for abdominal aortic aneurysm, has not been addressed in patients with aneurysm of the ascending aorta. Our study aimed to demonstrate the prevalence of ABO blood groups among one of the largest Iranian population with diagnosed aneurysm of the ascending aorta. A retrospective study was conducted in Tehran Heart Center in Tehran, Iran reviewing profile of 24,433 patients admitted to the cardiac surgery ward between January 2005 and February 2012 to extract data of 96 patients with confirmed diagnosis of ascending aortic aneurysm (AAA). Frequency of blood groups was determined and risk factors and AAA-related complications and mortality were compared between different blood groups. Of ninety six patients with AAA, 38 patients (39.58%) had blood group A, followed by 16 patients with blood group B (16.66%), 12 blood group AB (12.5%), and 30 patients (30.25%) with blood group O. Cerebrovascular accident (CVA), peripheral vascular disease (PVD), and AAA-related mortality were more frequent in patients with blood group A. However, it did not reveal statistically significant difference (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Our study showed that risk factors for developing vascular disease are more prevalent in patients with blood group A and this blood group is associated with higher complication and mortality in AAA.

Research paper thumbnail of Association between Perioperative Parameters and Cognitive Impairment in Post-Cardiac Surgery Patients

The Journal of Tehran University Heart Center, Apr 3, 2015

Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery ... more Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery. One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change. The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change. Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.

Research paper thumbnail of A New Method for Extubation: Comparison between Conventional and New Methods

The Journal of Tehran Heart Center, Aug 1, 2012

BACKGROUND: Extubation is associated with the risk of complications such as accumulated secretion... more BACKGROUND: Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article.METHODS: The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting (CABG) were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas (ABG) analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile.RESULTS: In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen (PaO(2)/FiO(2)) ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO(2)/FiO(2) four hours after extubation, were statistically significant, however (p value=0.0063).CONCLUSION: The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation.

Research paper thumbnail of Transseptal Approach versus Left Atrial Approach to Mitral Valve: A Propensity Score Matching Study

PubMed, Oct 27, 2015

Background: Many patients with mitral valve diseases need surgical procedures for the repair or r... more Background: Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching. Methods: This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI). Results: The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274). Conclusion: In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.

Research paper thumbnail of Randomized Trial of Carnitine for the Prevention of Perioperative Atrial Fibrillation

Seminars in Thoracic and Cardiovascular Surgery, 2018

Atrial fibrillation (AF) is one of the most common complications in patients who undergo coronary... more Atrial fibrillation (AF) is one of the most common complications in patients who undergo coronary artery bypass graft surgery (CABG). The aim of this study was to evaluate the effect of L-carnitine administration on postoperative AF and the levels of C-reactive protein (CRP) following CABG. The effects of L-carnitine on the incidence of acute kidney injury after CABG were also assessed. One hundred thirty-four patients undergoing elective CABG, without a history of AF or previous L-carnitine treatment, were randomly assigned to an L-carnitine group (3000 mg/d L-carnitine) or a control group. CRP levels, as a biomarker of inflammation, were assessed in all the patients before surgery as baseline levels and 48 hours postoperatively. Neutrophil gelatinase-associated lipocalin, as a kidney biomarker, was also measured in the patients before surgery and 2 hours thereafter. The incidence of AF was 13.4% in our population. The incidence of AF was decreased in the L-carnitine group (7.5% in the L-carnitine group vs 19.4% in the control group; P = 0.043) and the postoperative CRP level (8.79 ± 6.9 in the L-carnitine group, and 10.83 ± 5.7 in the control group; P = 0.021). The postoperative neutrophil gelatinase-associated lipocalin concentration demonstrated no significant rise after surgery compared with the preoperative concentration (72.54 ± 20.30 in the L-carnitine group vs 67.68 ± 22.71 in the placebo group; P = 0.19). Our study showed that L-carnitine administration before CABG might inhibit and reduce the incidence of AF after CABG. It seems that a rise in the CRP level, as an inflammation marker, may be associated with the incidence of AF. Inflammation as measured by CRP was also reduced in the carnitine group, compared with the control group.

Research paper thumbnail of Utility of the CHA2DS2-VASc Score in Prediction of Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Surgery

Journal of Cardiothoracic and Vascular Anesthesia, May 1, 2022

OBJECTIVE The authors aimed to investigate the role of CHA2DS2-VASc score and its components in p... more OBJECTIVE The authors aimed to investigate the role of CHA2DS2-VASc score and its components in prediction of postoperative atrial fibrillation (POAF) after isolated coronary artery bypass graft (CABG) surgery. DESIGN Retrospective cohort. SETTING Single-center university-affiliated tertiary cardiac center. PARTICIPANTS A total of 2,981 consecutive patients who underwent isolated CABG between 2010 and 2012 were included. INTERVENTIONS All patients underwent isolated CABG and were followed until discharge or in-hospital death. The primary outcome was the development of new-onset POAF during the hospital course. MEASUREMENTS AND MAIN RESULTS During hospitalization, continuous electrocardiogram monitoring was used to detect POAF episodes. New-onset POAF developed in 15.8% of patients following isolated CABG. Patients with POAF had significantly higher CHA2DS2-VASc scores than those without POAF (2.66 ± 1.51 v 2.12 ± 1.36, p < 0.001). After adjustment for potential confounders, CHA2DS2-VASc score was significantly associated with POAF (odds ratio [OR]: 1.295, 95% CI: 1.205-1.391). However, further analyses showed that this effect was restricted to patients with a CHA2DS2-VASc score of ≥2 (OR: 1.813, 95% CI: 1.220-2.694). In multivariate analysis of the CHA2DS2-VASc components, age ≥75 (OR: 3.737, 95% CI: 2.702-5.168), age 65 to 74 (OR: 2.126, 1.701-2.658), hypertension (OR: 1.310, 95% CI: 1.051-1.633), and cerebrovascular accident (OR: 1.807, 95% CI: 1.197-2.726) were independent predictors of POAF. However, the association between POAF and female sex, diabetes mellitus, congestive heart failure, and vascular disease was not statistically significant. CONCLUSIONS CHA2DS2-VASc score is a useful tool for the prediction of POAF after isolated CABG. However, the risk should be interpreted cautiously, since the risk score's promising effect relies on only several of its components.

Research paper thumbnail of Role of Ventral Hippocampal GABA<sub>A</sub> and NMDA Receptors in the Anxiolytic Effect of Carbamazepine in Rats Using the Elevated Plus Maze Test

Pharmacology, 2009

Background: The successful use of antiepileptic drugs to treat a wide range of nonepileptic disor... more Background: The successful use of antiepileptic drugs to treat a wide range of nonepileptic disorders led us to evaluate the potential efficacy of carbamazepine (CBZ) in anxiety disorders. Anxiety may be related to the imbalance between γ-aminobutyric acid (GABA) and glutamate neurotransmitters, systems that are also involved in the CBZ effects. We investigated the role of these systems in the ventral hippocampus (VH) and their interactions with the CBZ effect on anxiety-like behavior in rats using the elevated plus maze. Methods: Animals received GABAergic and NMDA agents in a volume of 1 μl/rat, which was injected into the VH (0.5 μl for each side) 60 min after receiving systemic administration of CBZ. The test sessions took place 10 min later. Results: The systemic administration of CBZ increased the percentage of open arm time (%OAT) at the dose of 40 mg/kg, which is representative of an anxiolytic response. Intra-VH injection of the GABAA receptor agonist muscimol (0.25–1 μg/rat) in the absence or presence of an ineffective dose of CBZ (30 mg/kg) did not show any significant changes in the parameters of anxiety-like behavior. The administration of GABAA receptor antagonist bicuculline by itself decreased %OAT at a dose of 1 μg/rat, indicating possible anxiogenic effect. The antagonist (0.75 and 1 μg/rat) also decreased CBZ response. A microinjection of NMDA (0.125 and 0.25 μg/rat) decreased %OAT, which was reversed by the administration of CBZ (40 mg/kg). This indicates interaction between the two drugs. However, the NMDA receptor antagonist DAP-5 (1 μg/rat) significantly increased %OAT, but combined with the lower dose of CBZ (30 mg/kg), it did not trigger any response on anxiety-like parameters. Conclusion: Both GABAergic and NMDA systems in the VH play a role in modulation of anxiety-like behavior of rats. The anxiolytic-like effects of CBZ seem to be mediated, at least in part, through an interaction with GABAA and NMDA systems in the VH.

Research paper thumbnail of Ascending Aorta Aneurysm and Blood Group A among Iranian Patients

Thrombosis Research, Feb 1, 2013

Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demo... more Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demonstrating risk factors for this disease is essential for development of screening strategies for high-risk populations. Blood group although described as a potential risk factor for abdominal aortic aneurysm, has not been addressed in patients with aneurysm of the ascending aorta. Our study aimed to demonstrate the prevalence of ABO blood groups among one of the largest Iranian population with diagnosed aneurysm of the ascending aorta. A retrospective study was conducted in Tehran Heart Center in Tehran, Iran reviewing profile of 24,433 patients admitted to the cardiac surgery ward between January 2005 and February 2012 to extract data of 96 patients with confirmed diagnosis of ascending aortic aneurysm (AAA). Frequency of blood groups was determined and risk factors and AAA-related complications and mortality were compared between different blood groups. Of ninety six patients with AAA, 38 patients (39.58%) had blood group A, followed by 16 patients with blood group B (16.66%), 12 blood group AB (12.5%), and 30 patients (30.25%) with blood group O. Cerebrovascular accident (CVA), peripheral vascular disease (PVD), and AAA-related mortality were more frequent in patients with blood group A. However, it did not reveal statistically significant difference (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Our study showed that risk factors for developing vascular disease are more prevalent in patients with blood group A and this blood group is associated with higher complication and mortality in AAA.

Research paper thumbnail of Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Critical pathways in cardiology, Mar 1, 2017

Background: We investigated the association of the preoperative hemoglobin a1c (Hba1c) with occur... more Background: We investigated the association of the preoperative hemoglobin a1c (Hba1c) with occurrence of postoperative atrial fibrillation (POaF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. Methods: We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. all patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. the role of Hba1c as a predictor for the occurrence of atrial fibrillation was then evaluated. Results: a total of 109 (15.3%) patients developed POaF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. in the univariable and multivariable regression model, Hba1c was not a predictor for POaF. Conclusions: Serum level of Hba1c could not be used as a predictor for the development of POaF.

Research paper thumbnail of Distribution of ABO Blood Groups among Patients with Congenital Heart Defects

Journal of Pioneering Medical Sciences, Jun 1, 2016

Background: Although an association between congenital heart disease (CHD) and ABO blood group ty... more Background: Although an association between congenital heart disease (CHD) and ABO blood group types have been proposed, this relationship has not been well-established. The purpose of this study was to determine the distribution of different ABO blood groups according to CHD sub-types in a large population of patients undergoing surgical repair for CHD. Methods: In a retrospective review of hospital data registry, medical profiles of 34,239 admitted patients between January 2003 and December 2012 were reviewed to identify cases with CHD who had undergone surgical repair. CHD types, ABO blood groups and clinical and final outcomes were recorded. Results: Data from 1,155 patients were analyzed. We did not find an association of a blood group type and a particular CHD type. Similarly, we did not find an association between blood group types and outcomes. Conclusion: We did not find an association between blood group type and type of CHD or outcomes after CHD correction.

Research paper thumbnail of The effect of paroxetine on ouabain-induced toxicity in isolated guinea pig atria

PubMed, 2011

It has been reported that selective serotonin reuptake inhibitors (SSRIs) possess some cardiac ef... more It has been reported that selective serotonin reuptake inhibitors (SSRIs) possess some cardiac effects. In the present study we have investigated the effect of paroxetine (PX), a potent SSRI agent, on spontaneously as well as ouabain-induced arrhythmia beating isolated guinea-pig atria. The Guinea-pig heart was rapidly removed; the auricles were dissected out in oxygenated modified Krebs solution. The rate and force of spontaneous contractions were recorded isometrically with a photosensitive transducer. PX (1-16 µg/ml) caused a dose-dependent decrease in the rate of contractions (14-70%) and contractile force (8-16%). Ouabain alone (1.2 µg/ml) produced arrhythmia at 7.2 ± 1.5 min and asystole at 20.1 ± 3.1 min. Pretreatment with PX (4 µg/ml) significantly increased the time of arrhythmia onset to 19.8 min. In addition, PX prolonged the duration of action beating from 20.1 ± 3.1 min to 43.1± 2.6 and delayed the occurrence of asystole. The pattern of contractile force by PX + ouabain treatment was more regular than that observed after administration of ouabain alone. The above findings may the probably be due to the inhibition of cardiac Na(+) and Ca(2+) channels or autonomic nervous system. Results also suggest that PX may reduce the membrane conductance through inhibition of ionic channels to prevent ouabain-induced arrhythmia.

Research paper thumbnail of Knowledge management in cardiac surgery: the second tehran heart center adult cardiac surgery database report

The journal of Tehran Heart Center, 2012

The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a v... more The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. There were 24959 procedures performed: 19663 (78.8%) isolated coronary artery bypass grafting surgeries (CABGs); 1492 (6.0%) isolated valve surgeries; 1437 (5.8%) CABGs concomitant with other procedures; 832 (3.3%) CABGs combined with valve surgeries; 722 (2.9%) valve surgeries concomitant with other procedures; 545 (2.2%) surgeries other than ...

Research paper thumbnail of Anxiety-like behavior induced by histaminergic agents can be prevented by cannabinoidergic WIN55,212-2 injected into the dorsal hippocampus in mice

Pharmacology, Biochemistry and Behavior, 2010

In the present study, we investigate the effects of the histaminergic system and cannabinoid rece... more In the present study, we investigate the effects of the histaminergic system and cannabinoid receptor agents on anxiety-related behaviors and their interactions using the hole-board test on mice. Bilateral intra-CA1 administration of the CB1/CB2 receptor agonist, WIN55, 212-2 (0.1-0.5microg/mouse) did not modify exploratory behaviors in mice. On the other hand, intra-CA1 administration of CB1 receptor antagonist, AM251 (25 and 50ng/mouse) or histamine, pyrilamine and ranitidine (5-10microg/mouse) decreased the amount of head-dipping and increased the first head-dip, suggesting an anxiogenic-like response. Furthermore, our present data indicated that the co-administration of WIN55, 212-2 (0.25microg/mouse) with histaminergic agents, decreased the anxiogenic-like response of an effective dose (5microg/mouse) of histamine and pyrilamine, but not that of ranitidine. In addition, the results demonstrated that co-administration of an ineffective dose of AM251 (15ng/mouse) with histaminergic drugs did not alter the response induced by an ineffective dose (3.75microg/mouse) of either histamine or pyrilamine and ranitidine. In all experiments and doses, locomotor activity and other exploratory behaviors were not significantly changed. In conclusion, our results showed that there is a chance of partial interaction between the cannabinoidergic and the histaminergic systems of the dorsal hippocampus on anxiogenic/anxiolytic-like behaviors in hole-board test.

Research paper thumbnail of Surgical management of Sternal wound infection post cardiac surgery "single surgeon experience

Journal of Cardiothoracic Surgery, 2015

Sternal osteomyelitis and post sternotomy mediastinitis still stays as a severe life-threatening ... more Sternal osteomyelitis and post sternotomy mediastinitis still stays as a severe life-threatening complication after cardiac surgery. This study was conducted to evaluate the short and long term results of surgical management of deep sternal wounds infection (DSWI).

Research paper thumbnail of Distribution of ABO Blood Groups among Patients with Congenital Heart Defects

Journal of Pioneering Medical Sciences, 2016

Background: Although an association between congenital heart disease (CHD) and ABO blood group ty... more Background: Although an association between congenital heart disease (CHD) and ABO blood group types have been proposed, this relationship has not been well-established. The purpose of this study was to determine the distribution of different ABO blood groups according to CHD sub-types in a large population of patients undergoing surgical repair for CHD. Methods: In a retrospective review of hospital data registry, medical profiles of 34,239 admitted patients between January 2003 and December 2012 were reviewed to identify cases with CHD who had undergone surgical repair. CHD types, ABO blood groups and clinical and final outcomes were recorded. Results: Data from 1,155 patients were analyzed. We did not find an association of a blood group type and a particular CHD type. Similarly, we did not find an association between blood group types and outcomes. Conclusion: We did not find an association between blood group type and type of CHD or outcomes after CHD correction.

Research paper thumbnail of Anxiolytic-Like Effects and Increase in Locomotor Activity Induced by Infusions of NMDA into the Ventral Hippocampus in Rat: Interaction with GABAergic System

Basic and Clinical Neuroscience, 2014

Introduction: In this study, we investigated the role of N-Methyl-D-Aspartate (NMDA) receptors in... more Introduction: In this study, we investigated the role of N-Methyl-D-Aspartate (NMDA) receptors in the ventral hippocampus (VH) and their possible interactions with GABAA system on anxiety-like behaviors. Methods: We used an elevated-plus maze test (EPM) to assess anxiety-like behaviors and locomotor activity in male Wistar rats. Results: The results showed that intra-VH infusions of different doses of NMDA (0.25 and 0.5 μg/rat) increased locomotor activity, and also induced anxiolytic-like behaviors, as revealed by a tendency to increase percentage of open arm time (%OAT), and a significant increase in percentage of open arm entries (%OAE). The results also showed that intra-VH infusions of muscimol (0.5 and 1 μg/rat) or bicuculline (0.5 and 1 μg/rat) did not significantly affect anxiety-like behaviors, but bicuculline at dose of 1 μg/rat increased locomotor activity. Intra-VH co-infusions of muscimol (0.5 μg/rat) along with low doses of NMDA (0.0625 and 0.125 μg/rat) showed a tende...

Research paper thumbnail of Impact of Angiotensin-Converting Enzyme Inhibitors and Angiotensin Receptor Blockers on Mortality of Coronary Artery Bypass Grafting

Background There is controversy over the potential benefits/harms of the usage of angiotensin-con... more Background There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as regards the postoperative mortality of coronary artery bypass grafting (CABG). This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Methods Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 (46.38%) patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. Results The mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. Eighty-seven (0.86%) patients expired within 30 days. Multivariate analysis...

Research paper thumbnail of Randomized Trial of Carnitine for the Prevention of Perioperative Atrial Fibrillation

Seminars in Thoracic and Cardiovascular Surgery

Research paper thumbnail of Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Critical pathways in cardiology, Mar 1, 2017

We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of pos... more We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated. A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF. Serum level of HbA1c could not be used as a predictor for the development of...

Research paper thumbnail of Preoperative Hemoglobin A1c and the Occurrence of Atrial Fibrillation Following On-pump Coronary Artery Bypass Surgery in Type-2 Diabetic Patients

Critical pathways in cardiology, Mar 1, 2017

We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of pos... more We investigated the association of the preoperative hemoglobin A1c (HbA1c) with occurrence of postoperative atrial fibrillation (POAF) in type-2 diabetic patients who underwent isolated coronary artery bypass grafting. We prospectively studied 708 type-2 diabetes patients [433 men ([61.2%)], candidate for isolated coronary artery bypass grafting. Biochemistry profile was measured on the day of operation. All patients were telemonitored for 72 hours after operation for the occurrence of atrial fibrillation. The role of HbA1c as a predictor for the occurrence of atrial fibrillation was then evaluated. A total of 109 (15.3%) patients developed POAF. Patients in the atrial fibrillation group tended to be older, with prolonged longer diabetes, and have renal failure, chronic obstructive pulmonary disease, and hypertension. In the univariable and multivariable regression model, HbA1c was not a predictor for POAF. Serum level of HbA1c could not be used as a predictor for the development of...

Research paper thumbnail of Ascending Aorta Aneurysm and Blood Group A among Iranian Patients

Thrombosis Research, 2013

Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demo... more Ascending aortic aneurysm is a life threatening conditions leading to surgery in many cases. Demonstrating risk factors for this disease is essential for development of screening strategies for high-risk populations. Blood group although described as a potential risk factor for abdominal aortic aneurysm, has not been addressed in patients with aneurysm of the ascending aorta. Our study aimed to demonstrate the prevalence of ABO blood groups among one of the largest Iranian population with diagnosed aneurysm of the ascending aorta. A retrospective study was conducted in Tehran Heart Center in Tehran, Iran reviewing profile of 24,433 patients admitted to the cardiac surgery ward between January 2005 and February 2012 to extract data of 96 patients with confirmed diagnosis of ascending aortic aneurysm (AAA). Frequency of blood groups was determined and risk factors and AAA-related complications and mortality were compared between different blood groups. Of ninety six patients with AAA, 38 patients (39.58%) had blood group A, followed by 16 patients with blood group B (16.66%), 12 blood group AB (12.5%), and 30 patients (30.25%) with blood group O. Cerebrovascular accident (CVA), peripheral vascular disease (PVD), and AAA-related mortality were more frequent in patients with blood group A. However, it did not reveal statistically significant difference (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt;0.05). Our study showed that risk factors for developing vascular disease are more prevalent in patients with blood group A and this blood group is associated with higher complication and mortality in AAA.

Research paper thumbnail of Association between Perioperative Parameters and Cognitive Impairment in Post-Cardiac Surgery Patients

The Journal of Tehran University Heart Center, Apr 3, 2015

Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery ... more Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery. One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change. The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change. Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.

Research paper thumbnail of A New Method for Extubation: Comparison between Conventional and New Methods

The Journal of Tehran Heart Center, Aug 1, 2012

BACKGROUND: Extubation is associated with the risk of complications such as accumulated secretion... more BACKGROUND: Extubation is associated with the risk of complications such as accumulated secretion above the endotracheal tube cuff, eventual atelectasia following a reduction in pulmonary volumes because of a lack of physiological positive end expiratory pressure, and intra-tracheal suction. In order to reduce these complications, and, based on basic physiological principles, a new practical extubation method is presented in this article.METHODS: The study was designed as a six-month prospective cross-sectional clinical trial. Two hundred fifty-seven patients undergoing coronary artery bypass grafting (CABG) were divided into two groups based on their scheduled surgery time. The first group underwent the conventional extubation method, while the other group was extubated according to a new described method. Arterial blood gas (ABG) analysis results before and after extubation were compared between the two groups to find the effect of the extubation method on the ABG parameters and the oxygenation profile.RESULTS: In all time intervals, the partial pressure of oxygen in arterial blood / fraction of inspired oxygen (PaO(2)/FiO(2)) ratio in the new method group patients was improved compared to that in the conventional method; some differences, like PaO(2)/FiO(2) four hours after extubation, were statistically significant, however (p value=0.0063).CONCLUSION: The new extubation method improved some respiratory parameters and thus attenuated oxygenation complications and amplified oxygenation after extubation.