The Egyptian Cardiothoracic Surgeon (ECTS - E-Journal)
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Effect of Body Mass Index on Morbidity and Mortality in Patients Undergoing Coronary Artery Bypass Grafting
Full text linkBackground: Obesity affects cardiovascular morbidity and mortality, and it increases the risk of coronary artery disease. Despite that, several cardiac surgery risk stratification scores do not consider the effect of obesity on the outcomes. The objective of this research is to study the impact of body mass index (BMI) on morbidity and mortality after coronary artery bypass grafting (CABG) in Egyptian patients.
Methods: This prospective cohort study included 200 patients who underwent CABG for atherosclerotic coronary artery disease. Patients were divided into two groups, group A: patients with BMI ≥ 25 Kg/m2 and group B: patients with BMI < 25 Kg/m2. The mean age in group A was 56± 4.95 years vs. 54± 5.5 years in group B (p= 0.102). Male patients presented 58% of the population in group A vs 74% in group B (p= 0.017). 60% of patients were hypertensive in group A compared to 63% in group B (p= 0.66) and 62%, and 48% were diabetics in group A and B respectively (p= 0.04).
Results: Postoperatively, there was a significant increase in wound infection (40% vs 8%; p< 0.001), chest infection (47% vs. 10% p< 0.001), surgical re-exploration (28% vs. 1%; p< 0.001), prolonged ICU stays (5.3 ± 2.88 vs. 3.93 ± 1.71 days; p< 0.001), ward stay (11.28 ±8.9 vs. 5.48 ± 2.45 days; p< 0.001), mediastinitis (34% vs. 6%; p< 0.001), the occurrence of sternal wound sinus within 8 months (26% vs. 7%; p< 0.001), in group A more compared to group B. There was no difference in ejection fraction (54.2 ±7.38 vs. 54.7 ± 9.1%; p= 0.69) and mortality (4% vs. 2%; p= 0.68) between groups.
Conclusions: BMI 25 Kg/m2 or higher is associated with increased infectious complications and prolonged stay after CABG; however, it did not affect mortality. Optimizing body weight is recommended before elective surgery
Cardiac Myxomas: A single center experience and ten-years follow up
Full text linkBackground: Cardiac myxoma is a benign tumor that carries the risk of embolization and obstruction of the blood flow. The ideal surgical approach is still debatable. We present our experience in the surgical treatment of cardiac myxomas and its ideal surgical approach.Methods: We retrospectively analyzed the data for all patients who underwent surgical excision of cardiac myxoma at our institution over 11 years starting from January 2006 to December 2016. Descriptive statistics were used to present preoperative, operative and postoperative data and Kaplan Meier curve to plot long-term survival.Results: Twenty-one patients had surgical excision of a primary, single and sporadic cardiac myxoma. Thirteen patients (62 %) were females, and the mean age at operation was 55.2 years (range: 28 – 71 years). The location of myxomas was in the left atrium in 17 patients (81%) and right atrium in 4 patients (19 %). Dyspnea was the main presenting symptom (71.4%) followed by constitutional symptoms (28%), palpitations (23.8%), syncope (14.2%) and stroke (14.2%). A right atrial trans-septal incision was used in 76.5% of left atrial myxoma cases. Five patients had concomitant operative procedures (coronary artery bypass grafting (n=2), tricuspid valve repair (n=1), mitral valve replacement (n=1) and bullectomy (n=1)). Postoperative complications were reported in six patients (28.6%) (supraventricular arrhythmia (n=2), temporary conduction deficit (n=2), pulmonary atelectasis (n=1), and postoperative bleeding (n=1)). Early postoperative mortality occurred in one patient (4.76 %), and there were no late deaths related to myxoma.Conclusion: Surgical treatment of cardiac myxoma is safe with low morbidity and mortality. The right atrial trans-septal incision is the recommended surgical approach
Expected Returns and Risk in the Stock Market
No full textWe present new evidence on the predictability of aggregate market returns by developing two new prediction models, one risk-based, and the other purely statistical. The pricing kernel model expresses the expected return as the covariance of the market return with a pricing kernel that is a linear function of portfolio returns. The discount rate model predicts the expected return directly as a function of weighted past portfolio returns. These models provide independent evidence of predictability, with R2 of 16-19% for 1-year returns. We show that innovations in the pricing kernel are associated with the cash flow component of the market return
Could heart-type fatty acid binding protein predict clinical outcome in coronary artery bypass graft surgery?
Full text linkBackground: Detection of myocardial damage and its degree during open heart surgery were studied previously using different biomarkers. Heart fatty acid binding protein (h-FABP) was used in the diagnosis of myocardial infarction with variable results. In this study, we aimed to find the possibility of the use of this biomarker as a predictor of myocardial damage after coronary artery bypass graft (CABG) surgery.
Methods: We conducted a prospective study on 47 patients who had CABG surgery. Blood samples (4 ml) were drawn from patients at 5 points: before induction of anesthesia, after aortic declamping, 1 hour after declamping, 6 hours after declamping and one day after surgery. Levels of h-FABP and creatine kinase muscle/brain (CK-MB) were estimated, and the relationship between h-FABP and operative and postoperative outcomes were recorded.
Results: There were statistically significant correlations between higher levels of h-FABP measured immediately after aortic declamping and need for intra-aortic balloon (116.55 + 9.26 vs, 84.34 + 19.55 ng/ml; p= 0.022), inotropes (107.04+ 14.79 vs, 79.95 + 17.59ng/ml; p< 0.001), defibrillators (97.73 + 15.18 vs 81.59 + 20.31 ng/ml; p=0.016), and postoperative atrial fibrillation (99.94 + 17.83 vs 80.84 + 18.89ng/ml; p= 0.004). No mortality was detected in our study. h-FABP levels showed an early peak just after aortic declamping and reached baseline by postoperative day one. CK-MB peaked 1 hour after aortic declamping and remained elevated for more than 24 hours.
Conclusion: h-FABP is a cardiac biomarker that could be used as a rapid indicator of ventricular dysfunction and atrial fibrillation post-CABG surgery
Dialectal variation in clitic placement in Andalusian and Asturian Spanish negative infinitival imperatives
No full textRight-sided infective endocarditis complicating central venous line insertion: a case report
Full text linkAbstract
Infective endocarditis is a serious and potentially fatal complication of central venous line (CVL) placement in patients with diseased hearts. A man of 59 was admitted because of fever and dyspnea of 5 days duration. He was a known case of ischemic cardiomyopathy with frequent admissions to a local hospital. Two months earlier, a CVL was placed in right subclavian vein for drug administration. On examination, he was febrile and hypotensive with a systolic murmur in tricuspid and mitral areas. CVL- guide wire was radiographically visible. White blood cells and C-reactive protein were elevated. Echocardiography showed big vegetation on tricuspid valve (TV), severe mitral and tricuspid regurgitation and dilated left ventricle whilst coronary angiography revealed 3-vessel disease. Antibiotic therapy was followed by an open heart surgery during which the guide wire and valve vegetation were removed, TV was repaired, mitral valve was replaced and coronary artery bypass grafting was performed. Culture of blood, valve tissue and guide wire grew Staphylococcus Epidermidis. Despite intensive medical and surgical therapy, the patient succumbed on the 4th postoperative day
The effect of biventricular pacing on cardiac function after open heart surgery
Full text linkBackground: Temporary postoperative pacing could enhance recovery of the cardiac function. The right ventricular pacing (RV) is commonly used, but it can cause dyssynchronous contraction of both ventricles. Biventricular pacing (BV) could improve the systolic function by synchronizing the ventricular contraction. The aim of this study is to evaluate the effectiveness of biventricular pacing in improving the hemodynamics in the early postoperative period compared to other pacing modes.
Methods: This is a clinical crossover trial including 50 patients who underwent open cardiac surgery in the period from September 2017 to September 2018. Mean age was 46.78± 12.09 years, and 50% were males. Temporary pacing leads were attached to the anterior wall of the right ventricle 1-2 cm paraseptally and the lateral wall of left ventricle 1-2 cm paraseptally. Each patient was paced for 3 minutes in the first 1-4 postoperative hours with 20 minutes washout period between different pacing modes. Study endpoints included cardiac output, ejection fraction (EF) and wall motion abnormality.
Results: Biventricular and right ventricular pacing increased postoperative cardiac output (6.31± 1.28 and 5.2±0.72 L/min; respectively), but BV pacing was superior to RV pacing (P-value <0.001). The effect of BV pacing was more evident in patients with EF < 50% (7.27± 0.895 vs. 5.26 ± 0.634 L/min; p< 0.001). The postoperative EF improved during BV pacing (53.16± 4.71%) compared to RV pacing (49.4± 4.07%; P-value <0.001). Both BV and RV pacing were associated with less paradoxical septal wall motion abnormality (P-value <0.001).
Conclusions: Temporary postoperative biventricular pacing improves hemodynamics compared to right ventricular and no pacing. Routine BV pacing is recommended especially in patients with low ejection fraction
The Cycladic and Aegean islands in prehistory
No full textThis textbook offers an up-to-date academic synthesis of the Aegean islands from the earliest Palaeolithic period through to the demise of the Mycenaean civilization in the Late Bronze III period. The book integrates new findings and theoretical approaches whilst, at the same time, allowing readers to contextualize their understanding through engagement with bigger overarching issues and themes, often drawing explicitly on key theoretical concepts and debates. Structured according to chronological periods and with two dedicated chapters on Akrotiri and the debate around the volcanic eruption of Thera, this book is an essential companion for all those interested in the prehistory of the Cyclades and other Aegean islands.<br/
Predictors of Early Mortality After Aortic Valve Replacement in Middle-Aged Rheumatic Patients
Full text linkBackground: Several risk factors, including emergency surgery, predicted early mortality after aortic valve replacement (AVR). Euroscore II is used to predict the mortality after cardiac operations. We aimed to review our experience in AVR and determine the early mortality predictors
Methods: We collected the data of 200 rheumatic patients who had standard AVR in two centers. Median sternotomy and cardiopulmonary bypass were used in all patients. Transcatheter and minimally invasive aortic valve replacement patients were excluded. We used 15 types of aortic valve prostheses, either mechanical or biological. Follow-up echocardiography was done in the intensive care unit, on discharge, and one month after discharge.
Results: 128 patients (64%) had mechanical AVR, and 130 patients (65%) were males. The mean age was 48.2 ± 19 years, and body mass index was 1.8 ± 0.2 Kg/m2. The mean preoperative ejection fraction was 54 ± 9.4 %, end-diastolic dimension was 5.3 ± 0.8 cm, and end-systolic dimension was 3.5 ± 0.9 cm. Nine patients (4.5%) died in the early postoperative period (6 months). Euroscore II was the only factor significantly associated with early mortality (P value= 0.031). The mean Euroscore II was 1.3 ± 0.9 and 10.1 ± 10.7 for survivors and non-survivors, respectively.
Conclusion: Euroscore II score was significantly associated with early mortality after aortic valve replacement in rheumatic patients and can be used for risk stratification in those patients
