The Egyptian Cardiothoracic Surgeon (ECTS - E-Journal)
Not a member yet
46902 research outputs found
Sort by
Bentall Procedure for an Adolescent with Sickle Cell Disease, Hodgkin’s Lymphoma, and old Cerebrovascular Accident
Full text linkCardiopulmonary bypass (CPB) in patients with sickle cell anemia can trigger lethal vaso-occlusive crises, especially in cases of hypoxia, hypothermia, acidosis, or low-flow states. We described a patient with sickle cell anemia who had bicuspid aortic valve stenosis and aneurysmal dilatation of the ascending aorta complicated with infective endocarditis. The patient had a history of stroke. During routine workup, Hodgkin’s Lymphoma was diagnosed. The patient underwent exchange transfusion preoperatively and immediately before the initiation of CPB. We performed a Bentall procedure, and the patient was discharged in a stable condition. Sickle Cell Disease can be very challenging during CPB, and special precautions are required to prevent vaso-occlusive crises
Postoperative Outcomes of Minimally Invasive versus Conventional Mitral Valve Repair; A Randomized Study
Full text linkBackground: Minimally invasive mitral valve surgery (MIMVS) is associated with less surgical trauma. However, its advantages over the conventional approach are controversial. This study aims to compare the early postoperative pain, hospital stay, and pulmonary function between minimally invasive and conventional mitral repair.
Methods: Fifty patients with non-ischemic mitral valve disease who had mitral valve repair between 2017 and 2019 were included in the study. Patients were randomly divided into two equal groups. Group A (n=25) included patients who had minimally invasive mitral valve repair via anterolateral mini-thoracotomy with video assistance, and Group B (n=25) included patients who had mitral valve repair via median sternotomy.
Results: The cross-clamp (99.45±16.01 vs. 87. 5±19.16 min; p= 0.058) and the total bypass times (134.08±27.38 vs. 120.71±22.18 min; p= 0.35) were nonsignificantly longer in Group A. Operative time was significantly longer in Group A (207.08±44.31 vs. 173.54±28.25 min; p= 0.001). The ICU stay in Group (A) was 2.58±1.44 days, and in Group (B), the ICU stay was 3.75±1.77 days (p= 0.001). The hospital stay was 7.87±1.59 days in Group A, and 14.5 ±5.05 days in Group B (P<0.001). Postoperative FEV1 was 2.06±0.63 L in Group A and 1.39±0.43 L in Group B (p= 0.001). There was no difference in postoperative ejection fraction between both groups (p= 0.9).
Conclusion: Minimal invasive mitral valve repair could reduce postoperative pain, length of ICU, and hospital stay and improve the postoperative respiratory function when compared to the conventional approach
Effectiveness of daily fluid balance charting versus body weight measurement as a guide for fluid administration therapy after cardiac surgery
Full text linkBackground: Several studies have established a link between fluid overload and an increased risk of death. After cardiac surgery, patients' fluid status should be assessed at close intervals. A daily fluid balance (FB) has several limitations. This study aims to determine the agreement and correlation between fluid status changes calculated by the daily fluid balance through the conventional charting approach and body weight (BW) change using beds equipped with weighing scales.
Methods: This is a prospective observational study that included 50 patients who underwent cardiac surgeries. It evaluates the precision and usefulness of determining body fluid status and requirements using daily fluid balance and body weight measurements.
Results: The mean age of the study group was 52.9 ±10.44 years. The mean weight, height, and BMI were 87.1 ± 16.68 Kg, 170.4 ± 4.59 cm, and 30.12 ± 6.21 kg/m2. The mean duration of mechanical ventilation was 9.5 ±3.73 h. Mean ICU and hospitalization times were 2.4 ± 0.67 and 6.3 ± 1.36 days, respectively. The mean cumulative fluid balance was 0.52 ± 3.21 L, and the overall change in body weight (discharge weight − admission weight) was 0.55 ± 2.89 kg. There was a highly significant positive correlation between overall bodyweight and cumulative fluid balance (r- coefficeient= 0.947, p-value <0.001).
Conclusion: Bodyweight measured by weight-enabled beds could seem sufficiently robust or accurate to replace daily FB in ICU post open heart. Such measurement might be used to monitor overall changes in BW in patients with a prolonged ICU stay
Comparative Study Between Custodiol® versus Cold Blood Cardioplegia for Myocardial Protection in Double Valve Replacement Surgery
Full text linkBackground: Several cardioplegic solutions are available for myocardial preservation. The superiority of intracellular over extracellular cardioplegia is still debated. Our study aimed to compare the results of Custodiol® and blood Cardioplegia for myocardial protection in double valve replacement surgery.
Methods: This is a prospective study that included 301 patients. We grouped the patient into; Group A (n= 135) had Custodiol® cardioplegia, and Group B (n= 166) had cold blood cardioplegia. We included patients who had double valve surgery and excluded redo, emergency procedures, and patients who had concomitant coronary artery bypass grafting.
Results: Patients in Group A were significantly younger (43 ±9 vs. 47 ±10, P<0.001). There were 72 females (53.3%) in Group A and 71 (43.4%) in Group B (P= 0.09). The total bypass time was higher in group B (217± 40 vs. 179± 35 min, P< 0.001). The cross-clamp time was comparable between groups (90± 31 vs. 85± 29 min, P= 0.15). The duration of mechanical ventilation (7 ± 1 vs. 12 ± 2 h, P< 0.001), ICU stay (3± 0.7 vs. 4± 0.9, P< 0.001) and hospital stay (8± 1 vs. 13± 3, P< 0.001) were shorter in Group A. Postoperative wound seroma (5 (26.6%) vs. 60 (36.1%), P< 0.001) and mortality (2 (1.5%) vs. 11 (6.6%), p= 0.042) were lower in Group A.
Conclusion: Custodiol cardioplegia could be safe during double valve surgery. A larger randomized trial is required to confirm our findings
Ultrafast-track extubation after pediatric cardiac surgery; benefits and safety
Full text linkBackground: Ultrafast-track extubation after cardiac surgery my facilitate rapid recovery. However, the overall risk-benefit is still debatable. The objective of this study was to report the effect of ultrafast-track extubation in pediatric patients undergoing cardiac surgery.
Methods: This is a retrospective study that included 260 patients who had surgery for congenital heart diseases between 2015 and 2019. Patients were divided into two groups. Group A included patients who had ultrafast-track extubation protocol (n = 140), and group B was the conventional anesthesia group (n = 120).
Results: The mean age was 3.68 ± 2.1 and 3.8 ± 1.6 years for groups A and B, respectively (p= 0.08). The total operative time was higher in group A (326± 18.15 vs. 274.6±28.1 minutes; p 0.001), and the degree of pulmonary hypertension were higher in group B (p= 0.02). The rate of ventilator-related complications was higher in group B (P = 0.02). There was a significant reduction in mean length of intensive care unit stay between the ultrafast-track extubation and the conventional groups (65.3 ± 33.7 and 81.6±70.2 hours, respectively; p= 0.001). The total hospital stay was significantly reduced in group A (6.7 ± 2.7 vs. o 7.43±2.65 days for group A and B, respectively, p= 0.03).
Conclusions: The application of ultrafast-track extubation protocol could lead to a reduction in the ventilator-related complications, the length of intensive care unit and hospital stays without increasing postoperative complications
The effect of cold crystalloid versus warm blood cardioplegia on the myocardium during coronary artery bypass grafting
Full text linkBackground: The optimal cardioplegic solution is still debated. The objective of this study was to compare the effect of cold crystalloid versus warm blood cardioplegia on the myocardial injury during coronary artery bypass grafting.
Methods: The study included 34 consecutive patients who underwent elective primary on-pump isolated coronary artery bypass grafting from 2016 to 2019. We randomly assigned the patients into two groups. Group (ICCC) (n= 17) received intermittent antegrade cold crystalloid cardioplegia and Group (IWBC) (n= 17) received intermittent antegrade warm blood cardioplegia.
Results: There was no difference in the preoperative and operative variables between groups. The time taken by the heart to regain normal sinus rhythm was significantly longer in the cold crystalloid group (7.06 ± 1.8 vs. 2.17 ± 0.8 minutes, p<0.001) with a higher rate of reperfusion ventricular arrhythmia (35% versus 6%; p=0.03) compared to the warm blood cardioplegia group. Both coronary sinus acid production and lactate level were significantly higher in the warm blood group than in the cold crystalloid group (p< 0.001 and 0.043, respectively). The ischemic ECG changes and the severity of new segmental wall motion abnormalities were non-significantly different between both groups (p= 0.68 and 0.67, respectively). Postoperative CK-MB and cTnI levels in all-time points were not significantly different between groups (p= 0.46 and 0.37, respectively). ICU (2.29 ± 0.77 vs. 2.41 ± 0.87 days, p= 0.68) and hospital stay (9.28 ± 0.76 vs. 9.42 ± 0.88 days, p= 0.62) were non-significantly different between both groups.
Conclusion: Intermittent antegrade cold crystalloid cardioplegia was associated with attenuated myocardial metabolism. However, it was associated with a longer time to regain normal sinus rhythm and more reperfusion ventricular arrhythmias. We did not find differences in the clinical and echocardiographic outcomes and cardiac enzymes between cold crystalloid and warm blood cardioplegia
Recombinant Factor VIIa for The Management of Uncontrollable Bleeding Following The Repair of Acute Type A Aortic Dissection
Full text linkBackground: Bleeding is a serious complication after surgical repair of acute type A aortic dissection. Recombinant factor VIIa (rFVIIa) could be used for the management of severe bleeding; however, it could lead to thromboembolic events. We aimed to report our experience in using rFVIIa in the management of severe bleeding following the surgical repair of acute type A aortic dissection.
Methods: We performed a retrospective study, including patients who had surgery for acute aortic dissection type A and received rFVIIa, in the period between January 2012 and January 2019. We reported the amount of bleeding 4 hours before and after the administration of rFVIIa, the number of blood products transfused before and after the use of rFVIIa, thrombosis of the central venous line, as well as the presence of disseminated intravascular coagulation.
Results: There were ten patients (2 females and 8 males) out of 120 patients with acute type A aortic dissection, who required the use of rFVIIa for severe postoperative bleeding. The mean age was 67.7±10.5 years. The amount of drainage decreased from 889±585.6 ml during the 4 hours prior to the infusion, to 165±73.5 ml during the following 4 hours (p<0.001). The patients received 2752±1362.9 ml, and 618±483.3 ml packed RBCs before and after rFVIIa administration, respectively (p< 0.001). The patients received 1601±693.4 and 246±419.6 ml of fresh frozen plasma before and after the use of rFVIIa, respectively (p< 0.001). The prothrombin time decreased after the infusion of rFVIIa (42.7±32 and 17.1±8 seconds, p= 0.001). There were no clinical signs of thromboembolism after its use. Mortality occurred in five patients (50%).
Conclusion: In the life-threatening situation of uncontrollable bleeding following surgical repair of type A acute aortic dissection, rFVIIa may have benefits to control bleeding. Furthers studies are recommended
Management of glucose 6-phosphate dehydrogenase (G6PD) deficient patients undergoing open-heart surgery
Full text linkBackground: There are scarce studies on the management of glucose 6-phosphate dehydrogenase (G6PD) deficient patients during cardiac surgery. The purposes of this retrospective study were to present and evaluate our experience with G6PD deficient patients who underwent cardiac surgery with cardiopulmonary bypass (CPB).
Methods: We included 20 patients with G6PD deficiency who had cardiac surgeries from 2015 to 2019. We used free radical scavenging strategy and careful perioperative management. The patients were compared to a control group of 20 patients with normal G6PD enzyme activity who underwent the same type of operations in the same period.
Results: Males represented 80% of G6PD deficient patients. There were significant elevations in preoperative total bilirubin (1.03±0.33 vs. 0.57±0.11 mg/dl, p< 0.001) and reticulocytes (1.87±0.62 vs. 0.54±0.18%) in G6PD deficient patients. Valve surgery was done for 60% of G6PD deficient patients. There were no significant differences between both groups regarding the type of surgery, aortic cross-clamp, CPB, and total operative time. G6PD deficient patients had significantly lower postoperative hemoglobin levels (9.44±0.94 vs. 10.0±0.59 g/dl, p= 0.04) and significantly higher postoperative total bilirubin (1.51±0.51 vs. 0.98±0.45 mg/dl; p=0.002) and reticulocytes (1.85±0.51 vs. 0.57±0.13%; p< 0.001). There was no significant difference regarding postoperative urea and creatinine levels. Ventilation time (10.3±2.7 vs. 8.2±1.9 hours; p=0.01), ICU stay (3.1±0.87 vs. 2.3±0.71 days; p=0.004), and hospital stay (3.1±0.87 vs. 6.0±1.02 days; p<0.001) significantly increased in G6PD deficient patients. The mortality rate was 5% (one patient) in G6PD deficient patients.
Conclusion: Despite the management strategy, G6PD deficient patients undergoing cardiac surgery are more liable to hemolysis and hypoxia with more need for blood transfusion and longer ventilation time, ICU, and hospital stays when compared to patients with normal G6PD enzyme activity. Further research to improve the outcomes in G6PD deficient patients is required
Mitral valve repair for myxomatous mitral regurgitation; Respect or Resect
Full text linkBackground: The superiority of mitral repair using resection of the posterior leaflet versus neo-artificial chordea is still debatable. The objective of this study was to compare leaflet resection versus chordal replacement for mitral valve repair in patients with isolated myxomatous degeneration of the posterior mitral valve leaflet.
Methods: This study was conducted on 199 patients with severe symptomatic mitral regurgitation due to myxomatous mitral valve degeneration. Patients were grouped into two groups: Group (1): Respect technique which included 76 patients who had limited resection of the anterior leaflet, chordal transfer, and replacement of anterior leaflet chordae by polytetrafluoroethylene sutures, and placement of annuloplasty ring. Group (2): Resect technique included 123 patients where the operation was done by resecting the prolapsed mid scallop of the posterior leaflet and placement of flexible annuloplasty ring.
Results: There was no difference between both groups regarding gender. Patients in the Respect group were younger (37 (25th- 75th percentiles: 29- 44) vs. 54 (48- 60) years, P<0.001). The minimally invasive approach was more commonly used in patients who had resection techniques (20 (26.32%) vs. 106 (86.18%); P<0.001). Ischemic (99 (95- 106) vs. 79 (75- 82); P<0.001) and cardiopulmonary bypass times (134.5 (130- 138.5) vs. 99 (97- 104) min; P<0.001) were higher in the Respect group. Blood loss was more in the Resect group (370 (305- 390) vs. 550 (490- 600) ml; P<0.001). There were no differences in the postoperative complications between groups. ICU stay was longer in patients in the Resect group (5 (5- 6) vs. 7 (6- 8) days; P<0.001). Mitral valve gradient after 12 months was significantly higher in the Resect group (3 (3- 3.5) vs. 4 (3- 5) mmHg; P<0.001). Mitral valve reoperation was required more in patients in the Respect group (5 (6.58%) vs. 1 (0.81%); P= 0.03).
Conclusions: Both Respect and resect techniques for mitral valve repair had comparable outcomes and durability. The repair technique should be tailored according to the mitral valve pathology
Metoprolol versus low-dose sotalol for prevention of high-risk post coronary artery bypass grafting atrial fibrillation
Full text linkBackground: The optimal therapeutic strategy for high-risk postoperative atrial fibrillation (POAF) remains less well defined. Our objectives were to investigate the efficacy of prophylactic metoprolol versus low-dose sotalol regimens to prevent high-risk atrial fibrillation (AF) following coronary artery bypass surgery (CABG).
Methods: We assigned 113 consecutive patients referred for CABG to either metoprolol or low-dose sotalol regimen. The primary end-point was the frequency of POAF during the 6-week follow-up.
Results: Out of 113 patients enrolled, 52.2% % received metoprolol (n= 59) while 44.8% received sotalol (n= 54). The frequency of POAF at follow-up was significantly higher among the metoprolol group (59.3 % versus 50 %; P=0.017). The predictors of POAF were: age > 60 years (OR: 1.86 (1.01-4.41); P= 0.03), EF (OR: 2 (1.05-3.83); P= 0.02), and sotalol was protective against POAF (OR= 0.49%; (95% CI=0.25 -0.97); P=0.02). The length of hospital stay was significantly higher in the metoprolol group (7.5±1.3 % versus 6.1±1.2 days; P<0.001).
Conclusion: Prophylactic low-dose sotalol could be superior to metoprolol for the prophylaxis of POAF in high-risk patients. However, Larger prospective multicenter randomized trials are needed to confirm our findings