Using self -suture branching artificial vesssels in aortic arch surgery at Hanoi Heart Hospital

Background: For aortic arch surgery, the improvement of anastomosis technique, and the improvement of using self-suture branching artificial vessels have shortened the time and reduced the cost of surgery. The study aimed to evaluate the improved results of using self-suture branched artificial vessels in aortic arch surgery. Methods: A retrospective descriptive study of the use of self-suture branching artificial vessels in aortic arch surgery at Hanoi Heart Hospital from October 2018 to May 2021. Results: There were 33 cases of aortic arch replacement using self-suture branching artificial vessels. The rate of postoperative bleeding was 6.06%. The rate of artificial vessel infection is 0%. Conclusion: Using self-suture branching artificial vessels in aortic arch surgery is a safe and effective technique.

Outcomes of surgical treatment of Stanford type of aortic dissection at Hanoi Heart Hospital in the period 2015-2020

Background: Stanford type A aortic dissection is a complex disease and a serious surgical emergency. The diagnosis is determined based on diagnostic imagines. Surgery is the mainstay of treatment, with high mortality and morbidity. This study aimed to comment on clinical and paraclinical characteristics and evaluate the results of surgical treatment of type A aortic dissection at Hanoi Heart Hospital within 5 years from 2015 to 2020. Methods: Retrospective and descriptive study of patients diagnosed with type A aortic dissection who were surgically treated at Hanoi Heart Hospital from January 2015 to May 2020. Results: 109 cases were included in the study with the mean age of 56.0 ± 14.4; 50 - 60 age accounted for the highest percentage (30.3%); men accounted for 67.9%. Classic type A aortic dissection in 95 cases (87.2%). Chest pain was the main clinical symptom (91.7%); 4.6% came to the hospital in a state of cardiogenic shock and circulatory arrest. The rate of Marfan phenotype was 13.8%. The most common surgery is replacing the ascending aorta (45.9%); total replacement of the aortic arch accounted for 17.4%; Total root replacement and aortic arch accounted for 3.7%. The average aortic pairing time was 120.7 ± 41.0 minutes, the mean running time was 179.7 ± 57.0 minutes. Re-operative bleeding accounted for 6,4%; cerebrovascular accident accounted for 2,8%. The early mortality rate after surgery was 9.2%. The mean follow-up time was 24.93 ± 16.13 months, the mean survival time was 52.0 ± 1.9 months, the survival rate was 88.1% after 1 year and 85.3% after 5 years. Conclusion: Early mortality, postoperative complications and survival rate after follow-up were positive with surgical technique and conditions of anesthesia and resuscitation at Hanoi Heart Hospital.

Clinical and laboratory testing of oral anticoagulation therapy vitamin k antagonists at the emergency department of Hanoi Heart Hospital

Background: The most commonly used oral anticoagulant is acenocoumarol with the brand name is Sintrom and recently, warfarin with the brand name is Coumadin has begun to be used. Anticoagulation with vitamin K antagonists faces two main obstacles: the narrow therapeutic range and the effectiveness of the drug varies by many factors. Objective: " Current status of coagulation disorders in the treatment of anticoagulants with vitamin K antagonists. Understanding some factors affecting the goal of anticoagulant treatment". Method: Cross-sectional, retrospective, descriptive analysis of drug use and influencing factors of patients diagnosed with coagulopathy admitted to the emergency department at Hanoi Heart Hospital from April 2020 to August 2021. Results: There were 675 patients admitted to the hospital with blood clotting disorders. The average age is 60,17±10,13, the youngest is 30, the oldest is 90; 63 patients, accounting for 9.42%, need to be hospitalized for inpatient treatment; There are 108 patients, accounting for 16%, with bleeding and 18 patients, accounting for 2.7%, with thromboembolism or valve obstruction. Conclusion: Coagulation disorders during treatment with vitamin K antagonist anticoagulants is a common condition in the emergency department. However, the complication rate is not high. There are many factors that affect the patient's treatment goals and the drug use is a fairly common factor.

Surgical treatment of left-sided infective endocarditis in Hanoi Heart Hospital

Objective: to evaluate the short-term outcomes of surgical treatment of left-sided infective endocarditis (IE) in Hanoi Heart Hospital. Patients and Methods: A retrospective, cross-sectional and descriptive study on all patients underwent surgery for left-sided IE from 3/2015 to 3/2019 in Hanoi Heart Hospital. Result: 56 patients underwent surgery for left-sided IE in 4 years; the mean age was 45.8 ± 16.0; male-female ratio was 3.3/1. 9 patients (16.1%) had prosthetic valve endocarditis. Preopeative blood cultures were positive in 35.7%, the mainly microorganism was Streptococcus (21.4%). Emergency and urgent surgery was performed in 14.3%; the most frequently postoperative complication was kidney failure, the in-hospital mortality rate was 5.4%. During the average follow-up time of 36.6± 14.2 months, the recurrence rate of IE was 17.8%. Conclusion: surgical treatment of left-sided infective endocarditis is still a great challenge, the early recurrence and motality rate are high.

Comments of results after surgical replacement of mechanical mitral and aortic valve in children at Hanoi Heart Hospital

Objective: Assessment of early results after surgical treatment of mechanical mitral valve and aortic valve replacement in children at Hanoi Heart Hospital from 2004 to June 2019. Methods: Analysis and evaluation based on data collected from patients undergoing surgery and from the results of follow-up examination. Results: The total number of patients was 50, in which 34 cases of simple mechanical mitral valve replacement, 16 cases of simple mechanical aortic valve replacement. Average age of surgery: 7.58 ± 6.01 years (The lowest age is 7 months, the highest is 15 years). Male: 29 patients (58%), female: 21 patients (42%). Ultrasound before discharge and after 3 months, we found similar results: mean EF: mechanical mitral valve: 56.28 ± 10.67 %; Aortic valve: 54.72 ± 9.66% .Mean pressure : Mitral valve: 3.18 ± 1.25; Aortic valve: 12.12 ± 3.25 mmHg. INR index: mitral valve : 2.58 ± 1.20; Aortic valve: 2.34 ± 0.92. Complications of valve replacement: 2 cases of mitral valve replacement after surgery 3 years and 4 years; There was 1 case of aortic valve 5 years after surgery. Death immediately after surgery: mitral valve: 2 cases (5.88%); aortic valve: 1 case (6.25%); Late death: After 2 years, there was 1 case of death after mitral valve replacement; After 4 years, there was 1 case of death after aortic valve replacement. Conclusion: The results of heart valve replacement surgery in children are positive. It is necessary to have better equipment and experience in open heart surgery in low-birth-weight children in order to operate the disease as early and effectively as possible, in which the treatment of complications of heart failure and post-operative coagulopathy should be considered important.

Results of minimally invasive aortic valve replacement surgery through right thoracotomy at Hanoi Heart Hospital

Objectives: To evaluate results of minimally invasive aortic valve replacement surgery through right thoracotomy with some techinque improvements in Hanoi Heart Hospital. Methods: Surgery was performed via a small right thoracotomy in the second intercostal space. The third rib was detached by a wedge-shaped way using sternum saw. Cannulation approaches were central or peripheral depended on patients’ condition. Preoperative, perioperative, early results and follow-up data was collected and analysed. Results: There was 48 patients in the research. Mean age was 60,94 ± 11,53 (25-82), and 52,1% was male. 29,2% of patients had peripheral vascular disease. 22,9% underwent central arterial cannulation. 3 patients (6,3%) had pericardial adhesion. There was no early mortality, 2 patients had redo surgery due to excess bleeding. 1 patients had intestinal infarction. Mean follow-up time was 13,4 months. 91,3% of patients had NYHA I. 1 patients was dead due to intracerebral hemorrhage. Conclusions: With some improvements in techniques, minimally invasive aortic valve replacement surgery through right thoracotomy gave good early and midterm results in our center.

The result of using Steriod during cardiopulmonary bypass in children undergoing cardiac surgery

The results of steroid in pediatric after cardiac surgery with steroid during extracorporeal circulation. Objectives: Evaluating the clinical and laboratory characteristics in pediatric patients after cardiac surgery using steroid. Methods: A prospective, randomized, controlled clinical trial on 106 pediatric patients who underwent surgery requiring cardiopulmonary bypass at Hanoi Heart Hospital. Results: The rate of postoperative infection of the group using corticosteroids was 85.5%, the group not using corticosteroids was 96%. The rate of fever after surgery of the group using corticosteroids was 32.7%, the group not using corticosteroids was 35.3%. Troponin T concentration of group using corticosteroids was 1729.3 ± 1874.8 ng/L, group not using corticosteroids was 1855.0 ± 2658.0 ng/L. The time of mechanical ventilation and the time of recovery of the group using corticosteroids was 19.7 ± 23.6 hours and 61.8 ± 53.0 hours, the group not using corticosteroids was 19.8 ± 25.0 hours and 52 ,5 ± 39.1 hours. Conclusion: High-dose corticosteroids in this research did not cause adverse effects as mentioned in some studies, but did not bring any significant benefit to pediatric patients after cardiac surgery.

Evaluation of early feeding through nasogastric tube in patients after cardiovascular surgery at the Hanoi Heart Hospital

Objectives: The goal of the study was to describle and understand the factors related to the nasogastric tube feeding in patients after cardio-vascular surgery. Methods: The study involved 100 consecutive patients who underwent cardio-vascular surgery at Hanoi Heart Hospital from April 1 to August 3, 2019..All subjects underwent assessed with the early feeding through nasogastric tube after 6 hours operation. Main results: The mean age of the patients was 54.4 ± 14.5 years old. The percentage of men were 48%, BMI <18.5 were 25%, used inotropic drug were 46% and sedative were 27%. The incidence of patients with abdominal distension and vomiting were 13%. No complications related to early feeding. Factors related to the residual index were sedation and duration of mechanical ventilation. Conclusion: Early nasogastric tube feeding in patients after cardiac and vascular surgery is safe, feasible and feasible.

Prognostic factors of cerebral revascularisation in acute ischemic stroke at Hanoi Heart Hospital

Background: Considering the effectiveness of treatment for acute ischemic stroke (AIS)patients, the most expected method is immediate revascularization using intravenous thrombolysis or mechanical thrombectomy, or both methods. Objective: “Find factors related to post-treatment outcomes of acute ischemic stroke patients undergoing cerebral revascularization”. Method: Cross-sectional, prospective, descriptive analysis with convenient sample size. Results: From February 2018 to August 2021, 83 patients were hospitalized with a diagnosis of acute ischemic stroke or acute ischemic stroke and had cerebral revascularision either by thrombolysis or mechanical devices or both. 6.02% of them had cerebral thrombosis with mechanical devices and stenting of cerebral/carotid arteries. Mean age was 66.37±11.82 (range 31to 91 years). Mean NIHSS score was 12.57±6.70. The rate of complete recanalization was 91.56%. The mRS score of 0-2 points accounted for 48.19% at the time of discharge and 54.21% at 30 days after discharge. The rate of death or severe illness at discharge accounted for 14.45%. 30 days all-cause mortality after discharge accounted for 25.3%. Conclusion: The rate of complete reperfusion in patients with acute cerebral infarction at Hanoi Heart Hospital and good recovery rate is quite high. Factors that related to the treatment efficacy of patients with acute ischemic stroke were NIHSS score, ASPECT score, occlusion site, pre-reperfusion parenchymal damage and the selection of appropriate reperfusion measures.

Clinical, paraclinical characteristics and real –world treatment of acute heart failure at Hanoi Heart Hospital

Background: At Hanoi Heart Hospital, in recent years, along with the development of science and technology, the development of modern treatment measures such as percutaneous coronary intervention, coronary artery bypass surgery, heart valve replacement ... helped save the lives of many patients. However, these patients still require continued treatment for heart failure as a complication of the primary illness and thus also increase the number of patients with heart failure, both acute and decompensated. Objective: “Describe the clinical and subclinical characteristics of hospitalized patients with acute heart failure and the status of heart failure treatment according to current heart failure treatment guidelines at Hanoi Heart Hospital”. Method: Cross-sectional, prospective, descriptive analysis with convenient sample size. Results: From January 2018 to december 2018, 475 patients were hospitalized due to acute heart failure or decompensation ,63,8% male and 36, 2% female. Mean age 69,1 ± 13,8; 63,6% newly discovered heart failure; 41,4% EF 40 – 50% and 58,6% EF < 40%; number of Hopital days 8.3 ± 6.2 days(( 1- 46 days); there are five (1.1%) patients died in hospital; among them a patient who was treated for one day due to severe illness died; we have used interventions, assisted circulation and respiration such as CRT, CRT-D, CVVH, IABP, atrial septal defect and ECMO. Conclusion: Results of treatment of acute heart failure at Hanoi Heart Hospital is feasible with rate of discharge is 87,7%.