BackgroundPostoperative junctional ectopic tachycardia is one of the most serious arrhythmias that occur after pediatric cardiac surgery, difficult to treat and better to be prevented. Our aim was to assess the efficacy of prophylactic dexmedetomidine in preventing junctional ectopic tachycardia after pediatric cardiac surgery.Methods and ResultsA prospective controlled study was carried out on 90 children who underwent elective cardiac surgery for congenital heart diseases. Patients were randomized into 2 groups. Group I (dexmedetomidine group): 60 patients received dexmedetomidine; Group II (Placebo group): 30 patients received the same amount of normal saline intravenously. The primary outcome was the incidence of postoperative junctional ectopic tachycardia. Secondary outcomes included bradycardia, hypotension, vasoactive inotropic score, ventilation time, pediatric cardiac care unit stay, length of hospital stay, and perioperative mortality. The incidence of junctional ectopic tachycardia was significantly reduced in the dexmedetomidine group (3.3%) compared with the placebo group (16.7%) with P<0.005. Heart rate while coming off cardiopulmonary bypass was significantly lower in the dexmedetomidine group (130.6±9) than the placebo group (144±7.1) with P<0.001. Mean ventilation time, and mean duration of intensive care unit and hospital stay (days) were significantly shorter in the dexmedetomidine group than the placebo group (P<0.001). However, there was no significant difference between the 2 groups as regards mortality, bradycardia, or hypotension (P>0.005).ConclusionProphylactic use of dexmedetomidine is associated with significantly decreased incidence of postoperative junctional ectopic tachycardia in children after congenital heart surgery without significant side effects.

Abstract: Background: Mortality is the most commonly used outcome measure after cardiac surgery. Various risk scores were developed to predict mortality after cardiac surgery with many differences among these scores. We evaluated the accuracy of Acute Physiology And Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score and Cardiac Surgery Score (CASUS) in predicting mortality in our patient population. Methods: Between October 2015 and December 2017, 103 adult patients who underwent open heart surgery were evaluated. The clinical characteristics, outcomes and risk scores data of the patients were collected. Accuracy of the scores was assessed using receiver operating curve (ROC) and the multivariate logistic regression analysis. Results: 103 patients were enrolled with mortality rate of 10.3%.  The non-survivors group showed statistically significant lower E.F, higher platelet count, higher bilirubin level and lower Po2 level (P value: 0.015, 0.020, 0.038, 0.006) respectively. Both APACHE II and SOFA scores performed better than CASUS score in predicting mortality in this study. However, APACHE II score (Area Under Curve “AUC”:0.878, sensitivity: 80%, specificity: 78.5%) and the preoperative platelet count independently predicted mortality after cardiac surgery. Conclusion: Both APACHE II and SOFA scores showed a high power in predicting mortality after cardiac surgery but APACHE II score rises as the best tool for risk stratification in our patient population. Keywords: Mortality; Cardiac surgery; Risk scores.

Objective: To compare the outcome of off-pump and on-pump coronary artery bypass graft surgery in patients with left main coronary artery disease.Method: The randomised, controlled, prospective, multicentric study was conducted in 2020 during the period from January 2020 to December 2020 at Kafrelsheikh University Hospital, International Cardiac Centre and Alexandria New Medical Centre, Egypt, and comprised patients with left main coronary artery disease who underwent coronary artery bypass graft surgery. The patients were randomised to on-pump surgery group I (Control Group) and off-pump surgery group II(Interventional Group). All patients were assessed pre-operatively for the presence of comorbid conditions and post-operatively for myocardial infarction, acute kidney injury, pneumonia, sternal dehiscence and 3-month mortality. Data was analysed using SPSS 20.Results: Of the 60 patients, 44(73.3%) were men and 16(26.6%) were women. The overall mean age was 66.4±9.2 years. There were 30(50%) patients in each of the two groups. There were 2(6.7%) cases of myocardial infarction in group I and 1(3.3%) in group II. There was 1(3.3%) case of acute kidney injury in group I and none in group II. There were 3(10%) cases of pneumonia in group 1 compared to 1(3.3%) in group II. There was 1(3.3%) case of sternal dehiscence in group I and none in group II. Mortality at 3 months was 2(6.7%) in group I and 1(3.3%) in group II. There was no significant difference with respect to outcome between the groups (p>0.05).Conclusion: Off-pump coronary artery bypass graft surgery was found to be efficient and non-inferior to on-pump procedure in patients with left main coronary artery disease.Keywords: Coronary artery, Bypass, Myocardial infarction, Kidney, Diabetes, Myocardium, Pneumonia

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Objectives: To assess safety; efficacy and efficiency of mini-sternotomy in aortic valve replacement in comparison to conventional sternotomy on short term follow up.Methods: This comparative study between 45 patients having aortic valve replacement via full sternotomy versus 45 others planned for upper j-shaped mini-sternotomy, was conducted from May 2019 to February 2022 in Kafrelsheikhuniversity hospital, Egypt. Data was collected and statistically analysed to assess outcomes.Results: Mini-Sternotomy approach was compared to conventional approach on the aspects of cardio pulmonary bypass (CPB) (p=0.153) and cross clamp (CC) time (p=0.673),. There was significantly less postoperative bleeding (p<0.001), rate of blood transfusion (p<0.001), duration of ICU stay (p=0.013) and total hospital stay (p=0.022) in ministernotomy approach in comparison to conventional sternotomy.Conclusion: For primary isolated AVR, less invasive techniques are a realistic, practical, and good alternative that offers better postoperative results than Full Sternotomy.Keywords: Aortic valve, sternotomy, Blood Transfusion, Pain, Intensive Care Units