Papers by Stavros Siminelakis
CHEST Journal, 2005
CONCLUSION: There seem to be some exceptions to the general rules of Cardiothoracic surgery conce... more CONCLUSION: There seem to be some exceptions to the general rules of Cardiothoracic surgery concerning Risk stratification and decision making. The unexpected results of prompt and aggressive Surgical treatment of otherwise fatal situations make out for these ...
CardioVascular and Interventional Radiology, 2006
Thoracic and abdominal aortic endovascular procedures as alternatives to aortic reoperations were... more Thoracic and abdominal aortic endovascular procedures as alternatives to aortic reoperations were studied in three different cases. An anastomotic aneurysm after previous thoracic aortic graft for coarctation, a second-stage elephant trunk repair (descending thoracic aortic aneurysm), and a secondary aneurysm proximal to a previous abdominal aortic graft were successfully treated with endovascular stent-grafts. During the follow-up period no lethal events or major aortic or graft-related complications were observed, except a type II endoleak in the anastomotic aortic aneurysm case. An endovascular stent-graft can be safely deployed into a previously implanted vascular graft, avoiding repeat surgery.
Cardiovascular diseases are among the leading causes of death in women. Significant gender differ... more Cardiovascular diseases are among the leading causes of death in women. Significant gender differences have been reported among patients with symptomatic carotid artery disease. The aim of this study is to examine if the female sex is a predisposing factor for carotid stenosis in coronary artery bypass grafting (CABG) patients. We studied 965 CABG patients, 796 males and 169 females. We combined the gender with risk factors predicting carotid disease as a history of cerebrovascular accident (CVA), peripheral vascular disease (PVD), left main (LM) disease and advanced age. We compared the incidence of carotid disease for each gender against known risk factors, which are history of CVA, PVD, LM and advanced age. In our study, there was not a statistically significant difference for the presence of carotid disease between males and females undergoing CABG. However, patients with a history of CVA, with PVD and older age were at greater risk for carotid stenosis. We conclude that the fem...
European Journal of Cardio-Thoracic Surgery, 2011
Vasa vasorum (VV) are microscopic vases that perfuse the vessel&a... more Vasa vasorum (VV) are microscopic vases that perfuse the vessel's wall; arteries and veins. Many recent researches support the opinion that VV have a significant role in aortic pathology. The VV, or 'the vessels of the vessels', form a network of microvessels that lie in the adventitia and penetrate the outer media of the host vessel wall. Although the importance of the VV in providing nutritional support is not well known, obstruction of blood flow through these vessels has been implicated in the pathogenesis of many cardiovascular diseases such as aortic intramural hematoma, aortic aneurysm, and acute or chronic aortic dissection. Although the proliferation of VV due to atherogenic stimuli is controversial, experimental and clinical studies strongly suggest the potential of VV in vascular proliferative disorders. It seems that the rupture of VV is implicated in intramural hematoma, which can develop in acute aortic dissection. In this review article, we would like to stress the anatomy and mainly the pathophysiology, and the implication of VV in the acute and chronic aortic pathologies.
Journal of Cardiac Surgery, 2009
Performing axillary artery cannulation, during cardiopulmonary bypass in patients with an atheros... more Performing axillary artery cannulation, during cardiopulmonary bypass in patients with an atherosclerotic ascending aorta or acute dissection of the ascending aorta and arch, is of growing interest. Our aim is to present our experience, to describe the surgical technique, and to demonstrate the sufficient cerebral and total body perfusion through axillary artery cannulation. Twenty-two patients (17 male, five female) underwent surgical treatment with the axillary technique. The log euro SCORE ranged from 6.77% to 70% (mean 28.28). Nine of these patients underwent elective procedure. Eight underwent aortic surgery for pathologies of the aorta and in one patient we performed combined aortic valve replacement and coronary artery bypass grafting. Thirteen patients underwent emergency operation because of acute dissection of the aorta. Twelve of these patients had a type A dissection (according to Stanford classification) and one patient had a type B aortic dissection. The majority of complications were associated with ruptured dissection of the thoracoabdominal aorta and acute dissection of ascending aorta. Despite preoperative disease states that placed our patients at high risk of stroke and visceral end-organ injury, no clinically demonstrable permanent postoperative deficits were observed. Our patients had no neurological dysfunction, stroke, or other complications. Antegrade cerebral perfusion is of paramount importance in cases of aortic atherosclerosis or aortic dissection. The axillary artery provides an excellent site for safe antegrade perfusion, which may play a role in preventing stroke.
Heart, Lung and Circulation, 2010
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Journal of Cardiothoracic Surgery, 2010
Preoperative medication by inhibitors of angiotensin-converting enzyme (ACE) in coronary artery p... more Preoperative medication by inhibitors of angiotensin-converting enzyme (ACE) in coronary artery patients predisposes to vasoplegic shock early after coronary artery bypass grafting. Although in the majority of the cases this shock is mild, in some of them it appears as a situation, "intractable" to high-catecholamine dose medication. In this study we examined the possible role of prophylactic infusion of low-dose vasopressin, during and for the four hours post-bypass after cardiopulmonary bypass, in an effort to prevent this syndrome. In addition, we studied the influence of infused vasopressin on the hemodynamics of the patients, as well as on the postoperative urine-output and blood-loss. In our study 50 patients undergoing coronary artery bypass grafting were included in a blindrandomized basis. Two main criteria were used for the eligibility of patients for coronary artery bypass grafting: ejection fraction between 30-40%, and patients receiving ACE inhibitors, at least for four weeks preoperatively. The patients were randomly divided in two groups, the group A who were infused with 0.03 IU/min vasopressin and the group B who were infused with normal saline intraoperativelly and for the 4 postoperative hours. Measurements of mean artery pressure (MAP), central venous pressure (CVP), systemic vascular resistance (SVR), ejection fracture (EF), heart rate (HR), mean pulmonary artery pressure (MPAP), cardiac index (CI) and pulmonary vascular resistance (PVR) were performed before, during, and after the operation. The requirements of catecholamine support, the urine-output, the blood-loss, and the requirements in blood, plasma and platelets for the first 24 hours were included in the data collected. The incidence of vasodilatory shock was significantly lower (8% vs 20%) in group A and B respectively (p = 0,042). Generally, the mortality was 12%, exclusively deriving from group B. Postoperatively, significant higher values of MAP, CVP, SVR and EF were recorded in the patients of group A, compared to those of group B. In group A norepinephrine was necessary in fewer patients (p = 0.002) and with a lower mean dose (p = 0.0001), additive infusion of epinephrine was needed in fewer patients (p = 0.001), while both were infused for a significant shorter infusion-period (p = 0.0001). Vasopressin administration (for group A) was associated with a higher 24 hour diuresis) (0.0001). In conclusion, low-dose of infused vasopressin during cardiopulmonary bypass and for the next 4 hours is beneficial for its postoperative hemodynamic profile, reduces the doses of requirements of catecholamines and contributes to prevention of the postcardiotomy vasoplegic shock in the patient with low ejection fraction who is receiving ACE preoperatively.
Heart, Lung and Circulation, 2010
W e present a 70-year-old man with massive haemothorax and traumatic left subclavian artery ruptu... more W e present a 70-year-old man with massive haemothorax and traumatic left subclavian artery rupture due to clavicle fracture , confirmed by a contrastmediated computed tomography . A dilemma between emergent classical thoracotomy and endovascular treatment appeared. He underwent a stent-graft placement of a 5 cm in length and 10 mm in diameter through the right femoral artery . Haemodynamic amelioration was note soon after the successful endovascular stent-grafting and patient remains asymptomatic months later. (N.G. Baikoussis).
Annals of Cardiac Anaesthesia, 2010
Cardiovascular disease in patients with congenital hypopituitarism is not rare; however, there is... more Cardiovascular disease in patients with congenital hypopituitarism is not rare; however, there is a lack of reports referring to cardiac interventions in such patients. We present a 76-year-old man with complete pituitary hormone deficiency, who presented with recurrent events of unstable angina. He had a significant stenosis of the left anterior descending artery and he underwent off-pump coronary artery bypass. Our aim is to present the successful management of this patient with congenital hypopituitarism who underwent cardiac surgery and to review the relevant literature.
Annals of Cardiac Anaesthesia, 2009
Journal of Cardiothoracic Surgery, 2010
During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CP... more During open heart surgery the influence of a series of factors such as cardiopulmonary bypass (CPB), hypothermia, operation and anaesthesia, as well as medication and transfusion can cause a diffuse trauma in the lungs. This injury leads mostly to a postoperative interstitial pulmonary oedema and abnormal gas exchange. Substantial improvements in all of the above mentioned factors may lead to a better lung function postoperatively. By avoiding CPB, reducing its time, or by minimizing the extracorporeal surface area with the use of miniaturized circuits of CPB, beneficial effects on lung function are reported. In addition, replacement of circuit surface with biocompatible surfaces like heparin-coated, and material-independent sources of blood activation, a better postoperative lung function is observed. Meticulous myocardial protection by using hypothermia and cardioplegia methods during ischemia and reperfusion remain one of the cornerstones of postoperative lung function. The partial restoration of pulmonary artery perfusion during CPB possibly contributes to prevent pulmonary ischemia and lung dysfunction. Using medication such as corticosteroids and aprotinin, which protect the lungs during CPB, and leukocyte depletion filters for operations expected to exceed 90 minutes in CPB-time appear to be protective against the toxic impact of CPB in the lungs. The newer methods of ultrafiltration used to scavenge pro-inflammatory factors seem to be protective for the lung function. In a similar way, reducing the use of cardiotomy suction device, as well as the contact-time between free blood and pericardium, it is expected that the postoperative lung function will be improved.
European review for medical and pharmacological sciences, 2012
Anastomotic pseudoaneurysm remains one of the main life-threatening complications after surgery o... more Anastomotic pseudoaneurysm remains one of the main life-threatening complications after surgery on the thoracic aorta. We report a case with a history of ascending and aortic arch replacement and a false aneurysm creation at the anastomotic line found at the 2-year follow-up computed tomography. Either, due to incidental and asymptomatic finding and patient negation to any kind of intervention, it has been followed the medical treatment with blood pressure and heart rate control. In this, we discuss also the ways of treatment and the indication of any interventional therapy. Endovascular stent-grafting is a minimal invasive treatment for thoracic aortic aneurysm. However, its clinical usefulness for anastomotic false aneurysm following thoracic aortic surgery is unclear.
Heart, Lung and Circulation, 2010
Interactive cardiovascular and thoracic surgery, 2010
Journal of Cardiothoracic Surgery, 2009
Background: Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventri... more Background: Left ventricular diastolic dysfunction (DD) is defined as the inability of the ventricle to fill to a normal end-diastolic volume, both during exercise as well as at rest, while left atrial pressure does not exceed 12 mm Hg. We examined the concept of left ventricular diastolic dysfunction in a cardiac surgery setting.
Journal of Cardiothoracic Surgery, 2010
This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis), unstab... more This the case of a 63 year-old man with end-stage renal disease (on chronic hemodialysis), unstable angina and significantly impaired myocardial contractility with low left ventricular ejection fraction, who underwent off-pump one vessel coronary bypass surgery. Combined continuous levosimendan and norepinephrine infusion (at 0.07 μg/kg/min and 0.05 μg/kg/min respectively) started immediately after anesthesia induction and continued for 24 hours. The levosimendan/norepinephrine combination helped maintain an appropriate hemodynamic profile, thereby contributing to uneventful completion of surgery and postoperative hemodynamic stability. Although levosimendan is considered contraindicated in ESRD patients, this case report suggests that combined perioperative levosimendan/ norepinephrine administration can be useful in carefully selected hemodialysis patients with impaired myocardial contractility and ongoing myocardial ischemia, who undergo off-pump myocardial revascularization surgery.
Interactive cardiovascular and thoracic surgery, 2010
Journal of Cardiothoracic Surgery, 2010
Antiphospholipid syndrome (APLS) is a rare syndrome mainly characterized by several hyper-coagula... more Antiphospholipid syndrome (APLS) is a rare syndrome mainly characterized by several hyper-coagulable complications and therefore, implicated in the operated cardiac surgery patient. APLS comprises clinical features such as arterial or venous thromboses, valve disease, coronary artery disease, intracardiac thrombus formation, pulmonary hypertension and dilated cardiomyopathy. The most commonly affected valve is the mitral, followed by the aortic and tricuspid valve. For APLS diagnosis essential is the detection of so-called antiphospholipid antibodies (aPL) as anticardiolipin antibodies (aCL) or lupus anticoagulant (LA). Minor alterations in the anticoagulation, infection, and surgical stress may trigger widespread thrombosis. The incidence of thrombosis is highest during the following perioperative periods: preoperatively during the withdrawal of warfarin, postoperatively during the period of hypercoagulability despite warfarin or heparin therapy, or postoperatively before adequate anticoagulation achievement. Cardiac valvular pathology includes irregular thickening of the valve leaflets due to deposition of immune complexes that may lead to vegetations and valve dysfunction; a significant risk factor for stroke. Patients with APLS are at increased risk for thrombosis and adequate anticoagulation is of vital importance during cardiopulmonary bypass (CPB). A successful outcome requires multidisciplinary management in order to prevent thrombotic or bleeding complications and to manage perioperative anticoagulation. More work and reporting on anticoagulation management and adjuvant therapy in patients with APLS during extracorporeal circulation are necessary.
European review for medical and pharmacological sciences, 2012
Extramedullary haematopoiesis is a very rare cause of a posterior mediastinal tumour and may be c... more Extramedullary haematopoiesis is a very rare cause of a posterior mediastinal tumour and may be clinically confused with many other mediastinal tumours; benign or malignant. Extramedullary haematopoiesis is a really rare cause of haemothorax and usually it is diagnosed incidentally. Extramedullary masses complicating thalassemias, apart from the known complications, may also bleed and produce acute manifestations like dyspnoea and fatigue. Pathologically, the masses are soft, deep red, and resemble spleen tissue on the cut surface. Histologically, they are formed of hematopoietic tissue mixed with adipose elements. The mass is extremely vascular and contains some fibrous tissue. This particular structure renders the mass prone to haemorrhage. We report a case of posterior mediastinal extramedullary haematopoietic mass in a 56-year-old man who presented with non-specific symptomatology and a paravertebral mass on chest X-ray and in the chest computed tomography. A percutaneous biopsy...
Journal of Cardiothoracic Surgery, 2009
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Papers by Stavros Siminelakis