No abstract

Background: In repair of tetralogy of Fallot (TOF), the use of monocusp to protect the right ventricle from volume overload is debatable. Aim of the work: study evaluates early outcome of pericardial monocusp in pulmonary position in transannular patch repair (TAP).

Background: The superiority of total arterial revascularization over the conventional method is a matter of continuous debate. Aim of the study: To compare early surgical and hospital outcomes of the total artery and conventional revascularization strategies in patients undergoing coronary artery bypass grafting (CABG).Patients and Methods: The study included 60 patients who underwent primary elective CABG from 2018 to 2020. Patients were grouped according to the revascularization strategy into two groups. Group 1 included patients who had conventional revascularization using left internal mammary artery (LIMA) and vein grafts (n= 30), and group 2 included patients who had total arterial coronary revascularization (TACR) (n= 30). Result: Patient who had TACR were significantly younger (48.43 ± 11.72 vs. 55.63 ± 3.97 years; P= 0.003). TACR patients had shorter cardiopulmonary bypass (53.70 ± 9.91 vs 61.83 ± 9.60 min; P= 0.002) and ischemia times (38.20 ± 7.78 vs 44.03 ± 7.23 min; P= 0.004). Blood loss and transfusion were significantly higher in patients in the conventional group (P= 0.01 and ˂0.001, respectively). TACR was associated with shorter mechanical ventilation (3.83 ± 0.95 vs. 4.80 ± 1.40 hours; P= 0.003), ICU (1.13 ± 0.35 vs. 1.47 ± 0.51 days; P= 0.004) and hospital stay (4.47 ± 0.63 vs. 6.04 ± 0.71 days; P= 0.001). After six months, angina and dyspnea classes were significantly better in the TACR group. Conclusion:The debate about the optimal CABG conduit is ongoing. Total arterial revascularization could be associated with favorable short and mid-term results.

Background: while cardiopulmonary bypass (CPB) has mainly been used to conduct the procedure of coronary artery bypass grafting (CABG) (Onpump CABG), CABG without cardiopulmonary bypass (off-pump CABG) may help limiting a number of known heart-lung machine's complications. Aim of the study: was to compare short term outcomes of both procedures (off-pump versus on-pump coronary artery bypass graft) in terms of efficiency and safety. Patients and Methods: this prospective randomized study was dedicated to assess the implementation of cardiopulmonary bypass in the cardiothoracic departments of both El Hussein and MKH Hospitals from August 2017 to July 2019. Results: regarding intraoperative data, operation time and the need for cardiac inotropes were significantly high in on-pump group. On the other hand, the total number of grafts utilized in on-pump group was 185 grafts while in off-pump group it was 177 grafts indicating no significant difference in terms of myocardial revascularization. Regarding postoperative data, the postoperative elevation of cardiac enzymes was significantly higher in on-pump group while ventilation time and duration of ICU stay were significantly less in time in off-pump group. Conclusion: off-pump CABG was easy to use and helped lowering the incidence of postoperative complication related to cardiopulmonary bypass with a decrease in both hospital stay and morbidity; there was no difference in post six months' follow-up, however, excellent results can be obtained with both techniques when done by expert hands .

Background: Reoperations after tetralogy of Fallot repair is common. This study aimed to report our indications, surgical procedures, and the clinical outcomes of patients undergoing reoperation after surgical correction of TOF. Patient and Methods: We included 40 patients who underwent reoperations after total TOF repair between 2015 and 2019. We included patients who had symptomatic right ventricular failure, patients with residual ventricular septal defect (VSD), right ventricular outflow tract obstruction (RVOTO), and tricuspid or pulmonary valve regurgitation. Results: The median age was 5.5(3.5-12.5) years, and 28(70%) were males. The median age at the time of primary repair was 2 (1-6) years. The end-systolic right ventricular (RV) volume estimated by MRI was 110.33±4.93 cc, and the end-diastolic volume was 208 ±10.08 cc. Twentytwo patients had VSD closure (55%), a transannular patch in 6 patients (15%), and RVOT resection in 14 patients(35%). Pulmonary valve replacement was performed in 6 patients(15%) and tricuspid valve repair in 4 patients (10%). The duration of postoperative mechanical ventilation was 11.5 (9-16.5) hours, and two patients had operative mortality (5%). Two patients (5%) had residual RVOT pressure gradient, and four patients had tiny residual VSD(10%). After six months of follow-up, four patients had moderate pulmonary regurgitation (PR), and four patients had residual VSD (10%). After one year follow-up, two patients had moderate PR(5%). Conclusion: A residual ventricular septal defect is a common indication for reoperation after the primary repair of tetralogy of Fallot. The results of reoperations are good with the accepted incidence of postoperative morbidity and mortality.