Complication Of Open Heart Surgery Research Articles

Relationship Between the Use of Topical Hypothermia with Ice Water to Postoperative Pulmonary Complications of Coronary Artery Bypass Graft

Introduction: Open heart surgery such as coronary artery bypass graft (CABG) is a heart surgery technique that uses a machine cardiopulmonary bypass (CPB) which can cause postoperative complications such as systemic inflammatory response syndrome (SIRS) and myocardial damage. Myocardial protection can be achieved through topical hypothermia techniques by lowering the heart temperature using a cold solution or ice cubes. Although several studies have shown its benefit in protecting the myocardium, the use of topical hypothermia remains controversial due to its uneven cooling effect and risk of tissue injury. This study aims to evaluate the relationship between the use of topical hypothermia of ice water and pulmonary complications of open heart surgery.
 Methods: This research is an analytical observational cohort retrospective comparison of pulmonary complications postoperatively in cardiac surgery patients who received systemic cardioplegia alone versus those who received a combination of systemic cardioplegia and topical hypothermia. Data collection was carried out using techniques consecutive sampling.
 Results: Of the 32 research subjects, the results of the analysis showed that the use of topical hypothermia did not have a statistically significant relationship (p>0.05) on the incidence of leukocytosis, pulmonary edema, duration of surgery, duration of ventilator use, duration of hospitalization, and mortality compared to the group that only received systemic cardioplegia. There was a significant relationship (p<0.05) between the incidence of pleural effusion in the topical hypothermia group.
 Conclusion: The use of topical hypothermia in cardiac surgery has a significant association with a higher incidence of pleural effusion.

Massive Right Ventricular and Pulmonary Artery Emboli In-Transit after Cardiac Surgery: Consideration of Non-Surgical Treatment

Background:Pulmonary embolism (PE) is a complication of open-heart surgery that accounts for 0.6% of all cases and its mortality rate varies from 50% to 100%. Here, we describe a case of right ventricular and pulmonary artery emboli in-transit. Case report: A 56-year-old female presented with complain of dyspnea and palpitation and history of recent coronary artery bypass graft (CABG) surgery. Edema of the right leg was noted. Trans-esophageal echocardiography (TEE) performed and revealed severe tricuspid regurgitation due to stucking clot in tricuspid valve. A large clot in right ventricle (RV) and right ventricle outflow tract (RVOT) with the size of 55 × 13mm was noted. There was also a clot with the size of 22 × 10mm in right pulmonary artery (RPA). Early in the ICU, patient received 10 units (18mg) of reteplase (IV) over 2 minutes and then 10 units was given with the rate of 1mg/hour after the first dose, with 30 minutes intervals. IV Heparin (18mg/Kg/h) was also co-administered with reteplase.There was no visible clot in RV and pulmonary artery in follow-up echocardiography. Patient transferred to CCU with stable hemodynamics and finally discharged with normal condition. Discussion: Surgery is an alternative in patients with massive PE but our patient had a prior cardiac surgery which re-operation had a high risk for her. Due to massive in-transient emboli of right heart and PA in our patient, we decided to proceed the treatment with reteplase. The patient was monitored carefully for hemodynamics and coagulation parameters and she was discharged without any systemic complication.

Neuroprotective effect of memantine on serum S100-B levels after on-pump coronary artery bypass graft surgery: A randomized clinical trial.

Background:Brain injury is one of the complications of open heart surgery. Glutamate plays a key role in this process. In this study, we evaluated the neuroprotective effect of memantine as NMDAR inhibitor in patients undergoing on-pump coronary artery bypass graft surgery (CABG).Methods:From July 2019 to May 2020, thirty-four consecutive patients selected for elective isolated on-pump coronary artery bypass graft surgery (CABG) enrolled in the trial. Patients were randomly assigned into two groups; memantine and the control group. For the memantine group, 10 mg of memantine twice daily was administered at least 72 h before surgery. Venous blood samples were collected before surgery (T1), at the end of cardiopulmonary bypass (CPB) (T2), 6h and 24h after CPB (T3 and T4). Serum concentration of S100-B was measured by enzyme-linked immunosorbent assay (ELISA) technique.Results:Serum S100-B increased during CPB with a peak plasma concentration at the termination of CPB. Then it gradually decreased during the first 24 hours in both groups (P=0.001). The mean S100-B levels were significantly lower in the memantine group compared to the control group at the termination of CPB (0.863±0.203 μg/l vs 1.117±0.304 μg/l), at 6 hours post-CPB (0.731±0.168 μg/l vs 0.938±0.206 μg/l), and 24 hours post-CPB (0.595±0.189 μg/l vs 0.852±0.227 μg/l), respectively (P=0.023). The mean level of serum S100-B in memantine group was about 0.19 μg/l less than the control group during the study (CI, 0.07 to 0.30; P=0.001). One (6.2%) patient in the control group had post-operative left arm paresthesiaConclusion:Administration of memantine before on-pump CABG can attenuate the post-operative concentrations of serum S100-B, which may reduce cerebral damage during surgery.

Constrictive Pericarditis after Open Heart Surgery: A 20-Year Case Controlled Study

BackgroundConstrictive pericarditis is a rare complication of open heart surgery (OHS), but little is known regarding the etiologic determinants, and prognostic factors. The purpose of this study was to investigate clinical predictors and long term prognosis of post-operative constrictive pericarditis (CP). MethodsUsing the Myocardial Infarction Data Acquisition System database, we analyzed records of 142,837 patients who were admitted for OHS in New Jersey hospitals between 1995 and 2015. Ninety-one patients were hospitalized with CP 30 days or longer after discharge from OHS. Differences in proportions were analyzed using Chi square tests. Controls were matched to cases for demographics, surgical procedure type, history of OHS, and propensity score. Cox proportional hazard models were used to evaluate the risk of all-cause death. Log-rank tests and Cox models were used to assess differences in the Kaplan-Meier survival curves with and without adjustments for comorbidities. ResultsPatients with CP were more likely to have history of valve disease (VD, p < 0.001), atrial fibrillation (AF, p = 0.024) renal disease (CKD, p = 0.028), hemodialysis (HD, p = 0.008), previous OHS (p < 0.001). Patients with CP compared to matched controls had a higher 7-year mortality (p < 0.001). This difference became statistically significant at 1-year after surgery. ConclusionCP is a rare complication of OHS that occurs more frequently in patients with VD, AF, CKD, HD, multiple OHS, and it is associated with an unfavorable long-term prognosis. Given the large number of OHS performed every year, the results highlight the need for clinicians to recognize and properly manage this complication of OHS.

The Effect of Orem Self-Care Program on Sleep Quality, Daily Activities, and Lower Extremity Edema in Patients Undergoing Coronary Artery Bypass Graft Surgery.

Background:Postoperative complications of open heart surgery require extensive care, especially by the patient. One of the important strategies in this regard is self-care education and one of the well-known patterns is Orem self-care model. This study aimed to investigating the effect of Orem-based self-care program on sleep quality, daily activities, and lower extremity edema in patients undergoing coronary artery bypass graft surgery.Materials and Methods:This clinical trial study was performed on 74 patients with coronary artery bypass graft surgery in Kashani Hospital in Shahrekord. The patients were randomly assigned to intervention and control groups. Data were collected using need assessment form according to the Orem model, quality of life and activity daily living questionnaire and measurement of edema by the meters. Data were analyzed using descriptive and analytical statistics with SPSS software.Results:The sleep quality score in the intervention group immediately after the intervention and 2 months after, was significantly lower in the intervention group than in the control group (P = 0.001). In the intervention group immediately after the intervention and 2 months after, the daily activity score was significantly higher than the control group (P < 0.05) 2 months after intervention, edema score in intervention group was significantly lower than the control group (P = 0.006).Conclusions:Results of the recent study showed that the implementation of the Orem-based self-care program can reduce the postoperative complications and the use of nursing patterns, such as Orem, to enhance self-care ability in patients who require long-term care can be very effective.

The Characteristics of Postoperative Mediastinitis During the Changing Phases of Cardiac Surgery

Mediastinitis is a serious complication of open heart surgery associated with high mortality, considerable health care costs, and prolonged hospital stay. We examined characteristics and incidence of mediastinitis during 29 years when indications and patient material have been in a process of change. This was a retrospective population-based study comprising all mediastinitis patients more than 16 years of age after open heart surgery between 1990 and 2018 from a population of 1.7 million. Patient records of 50 mediastinitis patients from 2004 to 2014 were reviewed and compared with 120 patients from 1990 to1999. Annual mediastinitis rate varied 0% to 1.5% with a decreasing trend-from a level exceeding 1.2% to approximately 0.3%-over the study period. In 2004 to 2014 patients with mediastinitis were older, more often smokers, and more often had diabetes mellitus and renal insufficiency than in 1990 to 1999. No difference in length of hospital treatment, antibiotic prophylaxis or treatment, intensive care unit treatment, or mortality was observed between 1990 to 1999 and 2004 to 2014. Coronary artery bypass graft surgery became less common and valve replacement and hybrid operations more common among operations leading to mediastinitis. Staphylococcus aureus increased (from 25% to 56%, p= .005) whereas coagulase-negative staphylococci (46% to 23%, P < .001) and gram-negative bacteria (18% to 12%, P= .033) decreased as causative agents. Surgery for mediastinitis remained similar except introduction of vacuum-assisted closure treatment. The rate of mediastinitis decreased during these 29 years. No difference in 30-day mortality in mediastinitis was seen: 0.9% in 1990 to 1999 and 2% in 2004 to2014.

Association Between SYNTAX Score and Carotid Artery Stenosis in Patients Undergoing Coronary Artery Bypass Graft (CABG)

Background: Stroke as a complication of open-heart surgery can be a cause of death and widespread disability. Objectives: This study aimed to determine the relationship between the SYNTAX Score and carotid artery stenosis and evaluate patients undergoing open-heart surgery in terms of postoperative complications and mortality in a six-month to two-year follow-up period. Methods: A cross-sectional study was conducted on 113 patients with CAD who underwent open-heart surgery at our hospital from 2016 to 2017. After collecting demographic data, the SYNTAX score, and color Doppler sonography report, the data were recorded and analyzed by SPSS22. Results: In our study, most patients were male and aged between 50 and 70 years. The mean SYNTAX score was 32.667 + 13.668 in the group with significant carotid stenosis, 33.926 + 9.387 in the group with no significant carotid stenosis, and 30.868 + 9.963 in the group without carotid stenosis. The results showed no significant relationship between carotid artery stenosis and the SYNTAX score (P = 0.512) and no significant relationship between the SYNTAX score and surgical complications (P = 0.666). Conclusions: According to the results, there is no significant relationship between the SYNTAX score and various indices related to heart disease, carotid artery stenosis, and postoperative morbidity and mortality. Thus, this index cannot be used to check and follow patients. However, further studies are needed to reach a definitive conclusion.

Abstract 266: Incidence, Predictors and Outcomes of Permanent Pacemaker Implantation Among Patients With Bradyarrhythmias Following Cardiac Surgery: Insights From the National Inpatient Sample Database

Introduction: Significant atrioventricular blocks and bradyarrhythmias are known complications of open-heart surgery. These are frequently transient, however, some patients go on to need a permanent pacemaker (PP). We sought to describe the incidence, predictors, and outcomes of PP implantation among patients admitted for cardiac surgery who develop bradyarrhythmias. Methods: We queried the National Inpatient Sample (NIS) database from 2010 to 2014 for adults admitted for surgical valve replacement, valvuloplasty or coronary artery bypass grafting (CABG) who had bradyarrhythmias during the admission using the appropriate ICD codes. We identified patients who had permanent pacemaker implantation documented during the admission. Categorical and continuous variables were compared using the chi-square and student's t-test. Predictors of PP implantation and in-hospital mortality were evaluated by logistic regression. Results: Of the 1402930 patients who underwent cardiac surgery, 94748 patients had bradyarrhythmias defined as sinoatrial node dysfunction (SND) and/or atrioventricular block (AVB) during hospitalization. The primary procedure was identified as valve replacement in 50.3% (47615 of 94748), CABG in 29.9% (27622 of 94748) and valvuloplasty in 8.7% (8248 of 94748). SND was found in 29.9% (28372 of 94748) and AVB in 76% (72017 of 94748). Permanent pacemaker implantation was done in 39.3% (37246 of 94748). Valve replacement was the most common surgery associated with PP implantation [58% (21682 of 37246) compared to 21.5% in CABG (8007 of 37246) and 7.7% in valvuloplasty (2882 of 37246), p &lt; 0.001). Female sex aOR 1.36 (95% CI 1.31 - 1.40), young age 18 - 44 years aOR 1.36 (95% CI 1.24 - 1.49), Asiatic and Hispanic origin aOR 1.36 (95% CI 1.23 - 1.51), aOR 1.25 (95% CI 1.17 - 1.34) respectively, diabetes mellitus with chronic complications aOR 1.16 (95% CI 1.09 - 1.24), drug abuse aOR 1.38 (95% CI 1.21 - 1.55) were associated with higher odds of pacemaker implantation. African American origin aOR 0.79 (95CI 0.74 - 0.85), AIDS aOR 0.33 (95% CI 0.17 - 0.67), south hospital region aOR 0.89 (95% CI 0.85 - 0.93), no-charge admissions aOR 0.66 (95% CI 0.49 - 0.89) were associated with a lower odds of PPM implantation. Death during hospitalization was found in 3% of the patients. After multivariable regression, PP implantation was associated with a lower likelihood of in-hospital death aOR 0.45 (95% CI 0.41 - 0.50). Conclusion: Approximately one-third of the patients hospitalized for cardiac surgery related to AVB and/or SND were implanted a permanent pacemaker. Factors like age, sex, race and comorbidities determine the likelihood of this procedure that has a significant impact on mortality. Having a better insight into these predictors would allow a better triage of patients who would benefit from its implantation.

P1836Constrictive pericarditis after open heart surgery: a 20-year case controlled study

Abstract Background Constrictive pericarditis (CoPe) after open-heart surgery (OHS) is a rare complication. Information on the incidence, determinants, and prognosis of this condition has been scarcely reported. Purpose To investigate the long term prognosis of CoPe after OHS. Methods Using the Myocardial Infarction Data Acquisition System database, we analyzed records of 144,902 patients that had OHS in New Jersey hospitals between 1995 and 2015. CoPe was identified in 79 patients after discharge. Differences in proportions were analyzed using chi square. Cases and controls were matched for demographics and comorbidities. Cox proportional hazard models were used to evaluate outcome risks. Log-rank test was used to assess differences in the Kaplan-Meier survival curves. Results Patients with CoPe were more likely to have history of valve disease (HVD) (p&lt;0.0001), atrial fibrillation (AF) (p=0.0006) and chronic kidney disease (CKD) (p=0.012). Significant predictors of CoPe were AF (HR 1.62, 95% CI 1.02–2.59), CKD (HR 2.70, 95% CI 1.53–4.76), diabetes (HR 1.73, 95% CI 1.08–2.80) and HVD (HR 3.11, 95% CI 1.88–5.15). Patients with CoPe compared to matched controls had a higher 10-year mortality (p&lt;0.0001). This became a statistically significant difference at 6 years after surgery (Figure). Survival Curve Conclusion Constrictive pericarditis is a rare complication of OHS and occurs more frequently in patients with AF, CKD, diabetes and HVD. It is associated with an unfavorable long-term prognosis. The data highlight the need for strategies to help prevent this complication. Acknowledgement/Funding Robert Wood Johnson Foundation

17Role of multi-detector computed tomography (MDCT) in diagnosing rare complication of open heart surgery

17Role of multi-detector computed tomography (MDCT) in diagnosing rare complication of open heart surgery

IMPACT OF AN EVIDENCE-BASED EDUCATIONAL PROGRAM ABOUT PEDIATRIC OPEN HEART SURGERY CARE ON BOTH NURSES AND PATIENTS' OUTCOMES

Open heart surgery (OHS), operations performed on the heart that require a child being placed on the heart-lung bypass machine. It is a common surgical procedure that can save lives and improve the quality of heart. Open heart surgery better treatable way of congenital heart disease and needs special care. Cardiothoracic surgical nurses key role in improving quality of children care through management of children to achieve optimal outcomes and prevents complications of open heart surgery. Aim: Evaluate the impact of an evidence-based educational program about pediatric open heart surgery care on both nurses and patient's outcomes. Methods: Quasi-experimental design for one group was utilized in carrying out the study at the Pediatric cardiology units at Mansoura University Children's Hospital and Institute of Heart in Damietta, on a sample of 40 nurses and 106 children undergoing open heart surgery for the first time, children in the age group from birth to 5 years, for at least 3 months. Data were collected by using three tools: Characteristics of studied nurses, structured interview questionnaire, nurses knowledge, nurses' reported practices regarding care of pediatric patient, and caregiver satisfaction scale Results: nurses’ knowledge about congenital heart diseases and open heart surgery in pediatric is generally low, reported practice of the nurses had an incompetent before conducting the program, while it improved to become competent and their practice of postoperative care for open heart surgery is unsatisfactory. While immediately after and follow-up the implementation of educational program significant improvements in nurses’ knowledge and practice was observed; all the areas were adequately performed by almost all nurses for almost all children in the study group. This is a positively reflected on child’s outcomes Conclusion: The implementation of the educational program regarding care pre, immediate and follow up of children with OHS had a positive effect on the improvements of nurses’ knowledge, practice and nurses' satisfaction. In addition, there were statistical significant differences between nurses’ knowledge and practice pre immediate and follow up the program were observed Recommendations: Regular and continuous educational programs for cardio surgical nurses are essential for improving their knowledge and practice about children' with open heart surgery.

IMPACT OF AN EVIDENCE-BASED EDUCATIONAL PROGRAM ABOUT PEDIATRIC OPEN HEART SURGERY CARE ON BOTH NURSES AND PATIENTS' OUTCOMES

Open heart surgery (OHS), operations performed on the heart that require a child being placed on the heart-lung bypass machine. It is a common surgical procedure that can save lives and improve the quality of heart. Open heart surgery better treatable way of congenital heart disease and needs special care. Cardiothoracic surgical nurses key role in improving quality of children care through management of children to achieve optimal outcomes and prevents complications of open heart surgery. Aim: Evaluate the impact of an evidence-based educational program about pediatric open heart surgery care on both nurses and patient's outcomes. Methods: Quasi-experimental design for one group was utilized in carrying out the study at the Pediatric cardiology units at Mansoura University Children's Hospital and Institute of Heart in Damietta, on a sample of 40 nurses and 106 children undergoing open heart surgery for the first time, children in the age group from birth to 5 years, for at least 3 months. Data were collected by using three tools: Characteristics of studied nurses, structured interview questionnaire, nurses knowledge, nurses' reported practices regarding care of pediatric patient, and caregiver satisfaction scale Results: nurses’ knowledge about congenital heart diseases and open heart surgery in pediatric is generally low, reported practice of the nurses had an incompetent before conducting the program, while it improved to become competent and their practice of postoperative care for open heart surgery is unsatisfactory. While immediately after and follow-up the implementation of educational program significant improvements in nurses’ knowledge and practice was observed; all the areas were adequately performed by almost all nurses for almost all children in the study group. This is a positively reflected on child’s outcomes Conclusion: The implementation of the educational program regarding care pre, immediate and follow up of children with OHS had a positive effect on the improvements of nurses’ knowledge, practice and nurses' satisfaction. In addition, there were statistical significant differences between nurses’ knowledge and practice pre immediate and follow up the program were observed Recommendations: Regular and continuous educational programs for cardio surgical nurses are essential for improving their knowledge and practice about children' with open heart surgery.

Effects of dexmedetomidine on heart arrhythmia prevention in off-pump coronary artery bypass surgery: A randomized clinical trial

BackgroundArrhythmia occurring during and after surgery is one of the major complications in open-heart surgery. Dexmedetomidine is an intravenous alpha-2 agonist and very specific short-acting drug to protect the various organs against ischemic injuries and blood reflow. However, the effect of dexmedetomidine for preventing intraoperative heart arrhythmias has not been recognized.ObjectiveThis study aimed to determine the effect of dexmedetomidine on the incidence rate of heart arrhythmias and anesthetic required in off-pump coronary artery bypass surgery.MethodsThis randomized clinical trial was conducted on patients who were candidates for off-pump coronary artery bypass referring to Imam Reza Hospital of Mashhad, Iran, from July 2016 through January 2017. The patients were randomly assigned to two groups of intervention (infusion of 0.5 mcg/kg/h dexmedetomidine together with induction followed by infusion of 0.5 mcg/kg/h by the end of the surgery) or control (saline infusion). Mean arterial pressure (MAP) and heart rate (HR) were measured before induction, during surgery operation and ICU admission. Data were analyzed by SPSS version 18 using Chi Square and independent-samples t-test.ResultsA total of 76 patients with a mean age of 59.8 ± 8.2 years (in two groups of 38) were studied. The two groups had no statistically significant difference in terms of background variables. The MAP and HR values before induction, during surgery and ICU admission were significantly higher in the control group than in the intervention group (p=0.001). Out of the studied arrhythmias, the values of PAC (55.2% vs. 15.7%), PVC (81.5% vs. 21.0%), AF (26.3% vs. 7.8%), VTAC (21.0% vs. 2.6%) were significantly lower in dexmedetomidine group (p=0.001).ConclusionIt seems that dexmedetomidine administration during induction and surgery can cause significant reduction in most of the common arrhythmias in off-pump coronary bypass surgery. The use of dexmedetomidine maintains MAP and HR at significantly lower values, and changes compared to the control group as well as reduces the need for anesthetic compounds.Trial RegistrationThe present study has been registered at the Iranian Registry of Clinical Trials (www.IRCT.IR) with a code of IRCT2016072413159N9 before starting the study.FoundingThis study was fully sponsored by the Research Deputy at Mashhad University of Medical Sciences, Iran (grant number 941413).

Preventing sternal wound infections after open-heart surgery.

SURGICAL SITE INFECTIONS are one of the most frequent postoperative complications for all surgical patients.1,2 A serious complication of open-heart surgery (OHS), sternal wound infections (SWIs) are linked to high mortality and morbidity.3 Preventing SWIs not only helps protect patients from severe

Use of intermittent high negative pressure vacuum-assisted closure for pediatric poststernotomy mediastinitis

IntroductionPostoperative mediastinitis is an infrequent, but potentially destructive, complication of open heart surgery, characterized by high morbidity and mortality, prolonged hospitalization and increased costs.1,2 Currently, there is no general consensus regarding the appropriate surgical appr

Recurrent large pericardial effusion after cardiac surgery presenting with reversible hyponatremia

Abstract: Pericardial effusion is a common complication of open heart surgery and more frequently occurs after coronary artery by-pass grafting. There are classical symptoms such as chest pain, dyspnea and orthopnea. However, hyponatremia is an unusual finding on presentation, and reported only three times in the literature. In this paper, a case in which recurrent pericardial effusion developed after coronary artery by-pass grafting presented with reversible hyponatremia was described. Hyponatremia was resolved rapidly, only after removal of large pericardial effusion by a successful pericardiocentesis. The possible mechanisms of reversible hyponatremia, relationship with pericardial effusion, and discrepancies about diagnosis were discussed, briefly.

Successful Implantation of Bipolar Epicardial Leads and Dual Chamber Pacemaker in Infant After Postoperative Atrioventricular Heart Block

Total atrioventricular (AV) block is inconvenient and serious complication of open heart surgery. Permanent total AV block requires the implantation of permanent pacemaker in order to allow normal hemodynamics and patient’s survival. In infancy additional challenge is the surgical approach, the selection of electrodes and PM, as well as place of implantation. We are publishing case report of successful double-chamber DDD pacemaker implantation at an infant born with Fallot tetralogy and with low birth weight due to complete AV block after primary surgical correction of these congenital defects.

Intraoperative aortic dissection.

Intraoperative aortic dissection is a rare but fatal complication of open heart surgery. By recognizing the population at risk and by using a gentle operative technique in such patients, the surgeon can usually avoid iatrogenic injury to the aorta. Intraoperative transesophageal echocardiography and epiaortic scanning are invaluable for prompt diagnosis and determination of the extent of the injury. Prevention lies in the strict control of blood pressure during cannulation/decannulation, construction of proximal anastomosis, or in avoiding manipulation of the aorta in high-risk patients. Immediate repair using interposition graft or Dacron patch graft is warranted to reduce the high mortality associated with this complication.

Preoperative, İntraoperative and Postoperative Predictors of Postoperative Respiratory System Complications in Patients Undergoing Open Heart Surgery

Preoperative, Intraoperative and Postoperative Predictors of Postoperative Respiratory System Complications in Patients Undergoing Open Heart SurgeryObjective: The increasing prevalence of risky cardiac operations and the changing patient profile, can cause more problems during intraoperative and postoperative periods.Problems related to the respiratory system in the postoperative period are also the most important causes of increased mortality and morbidity rates. The aim of the study was to determine the preoperative, intraoperative, and postoperative predictors of the respiratory complications of open-heart surgery patients.Material and Methods: 1401 patients undergoing open-heart surgery between 2000-2005 were evaluated retrospectively. Patients’ age, sex, body mass index, preoperative laboratory tests, left ventricular ejection fractions (LVEF, %), comorbid diseases, use of β-blockers ,smoking,type and duration of operation, cardiopulmonary bypass and anesthesia, transfusion of blood intraoperatively, time of extubation, amounts of mediastional drainage, length of stay in the ICU and in the hospital were recorded. The relationship between these predictors and postoperative respiratory complications is investigated. Results: In our study, the prevalence rate of postoperative respiratory complications among patients undergoing openheart surgery was found to be 39.2 %. The most common complication was prolonged mechanical ventilation (36.1 %), while the least frequent complication was pneumothorax (0.6 %). The mortality rate due to respiratory complications was 3.3 %. Risk factors for respiratory complications included older age, female gender, smoking, hypertension, COPD, higher rates of concomitant operations, preoperative hematologic and biochemical abnormalities, prolonged duration of CPB, anesthesia, operative, and extubation times, length of ICU and hospital stay, extra need for intraoperative transfusion of blood products and increased mediastinal drainage. Conclusion: Detailed examination of the patients preoperatively, and optimal treatment, could decrease complications of anesthesia and mortality rates by preference for the appropriate fast-tract anesthesia method which shortens duration of surgery, anesthesia and CPB.

Primary closure using Redon drains for the treatment of post-sternotomy mediastinitis

Post-sternotomy mediastinitis is a severe complication of open heart surgery resulting in prolonged hospital stay and increased mortality. Vacuum-assisted closure is commonly used as treatment for post-sternotomy mediastinitis, but has some disadvantages. Primary closure over high vacuum suction Redon drains previously has shown to be an alternative approach with promising results. We report our short- and long-term results of Redon therapy-treated mediastinitis. We performed a retrospective analysis of 124 patients who underwent primary closure of the sternum over Redon drains as treatment for post-sternotomy mediastinitis in Amphia Hospital (Breda, Netherlands) and St. Antonius Hospital (Nieuwegein, Netherlands). Patient characteristics, preoperative risk factors and procedure-related variables were analysed. Duration of therapy, hospital stay, treatment failure and mortality as well as C-reactive protein and blood leucocyte counts on admission and at various time intervals during hospital stay were determined. Mean age of patients was 68.7 ± 11.0 years. In 77.4%, the primary surgery was coronary artery bypass grafting. Presentation of mediastinitis was 15.2 ± 9.8 days after surgery. Duration of Redon therapy was 25.9 ± 18.4 days. Hospital stay was 32.8 ± 20.7 days. Treatment failure occurred in 8.1% of patients. In-hospital mortality was 8.9%. No risk factors were found for mortality or treatment failure. The median follow-up time was 6.6 years. One- and 5-year survivals were 86 and 70%, respectively. Primary closure using Redon drains is a feasible, simple and efficient treatment modality for post-sternotomy mediastinitis.