Background: Surgical treatment modalities of coronary artery diseases (CAD) include on-pump or off-pump coronary artery bypass grafting (CABG). CABG performed on the beating heart can avoid complications that might occur on cardiopulmonary bypass. Our objective was to compare the effectiveness of on-pump versus off-pump CABG in high-risk patients stratified according to the EuroSCORE scoring system. Methods: This randomized clinical study included 80 high-risk patients who underwent CABG and assigned into two groups; each contains 40 patients. Patients with valvular affection, ischemic ventricular septal defect or left ventricle and aortic aneurysms, and/or those exhibiting significant neurological pathology were excluded from the study. Study outcomes were blood loss, length of ICU and hospital stay, inotropic use, re-exploration rate, and operative mortality. Results: The study showed significant higher use of inotropic drugs intra and post-operatively (57.5% vs 40%, p = 0.021), more low cardiac output (12.5% vs 2.5%, p = 0.031), lower blood loss (337±67 vs 498±68 ml, p = 0.01), lower blood transfusion (1.1±0.2 vs 1.2±0.4 unit, p = 0.024), more prolonged ICU stay (4.0±1.6 vs 3.0±0.9 day, p = 0.001) and the higher re-exploration rate (17.5% vs 7.5%, p = 0.035) in the on-pump group. Hospital stay (8.7±2 vs 8.1±1, p = 0.121) and early mortality (7.5% vs 2.5%, p = 0.451) did not differ significantly between the two groups. Conclusion: Management of coronary artery disease is still challenging, and there is still a place for off-pump CABG in CAD in high-risk patients due to its advantages in the early complications while has the same total hospital stay when compared with on-pump CABG.
Background: Post traumatic clotted hemothorax is a serious problem associated with fluid loculation by fibrous adhesions, trapped lungs and increase the risk of infection and empyema. Intrapleural instillation of streptokinase may dissolve fibrin clots and membranes, break down adhesions and facilitate complete evacuation of residual blood clots and loculated effusions especially if given in the 1 st 7days post trauma. The aim of this study is to evaluate the effect of streptokinase injection as a fibrinolytic drug treating patients with clotted hemothorax within and after 1-week post trauma. Methodology of this study included 60 patients divided rondomly into 2 groups. Group A: include 30 patients with clotted hemothorax receiving streptokinase from 3rd to 7th day post trauma. Group B: include 30 patients with clotted hemothorax receiving streptokinase after 1-week post trauma. Results of this study revealed no difference between both groups regarding age, gender, side of affection or number of SK injection doses. There were a significant reduction in surgical intervention post SK injection (P = 0.004), period between trauma and SK use (P < 0.001) and failure of SK injection (P = 0.002) and total hospital stay (P <0.001) and CT results post SK injection (P = 0.001) in group A against group B. Conclusion:Intrapleural streptokinase injection could be an ideal option for post-traumatic clotted hemothorax before the decision is made to proceed to VATS or thoracotomy especially if given in the 1 st 7 days post trauma.
Background: 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.
Background: 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.
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