Journal of the Egyptian Society of Cardio-Thoracic Surgery最新文献

{"title":"Bidirectional Glenn procedure with and without cardiopulmonary bypass: Short term results","authors":"Ahmed Deebis, A. Gabal, Mohamed Abdel-Sadek, Ahmed S. Fadaly","doi":"10.1016/J.JESCTS.2017.07.006","DOIUrl":"https://doi.org/10.1016/J.JESCTS.2017.07.006","url":null,"abstract":"","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"30 5 1","pages":"343-348"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90798193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Systemic versus local analgesia for chest drain removal in post cardiac surgery patients: The taming of a beast","authors":"Mohammed Abd Al Jawad ,&nbsp;Ihab Ali ,&nbsp;Hoda Shokri ,&nbsp;Mohammed S. Shorbagy","doi":"10.1016/j.jescts.2017.08.006","DOIUrl":"10.1016/j.jescts.2017.08.006","url":null,"abstract":"<div><h3>Background</h3><p>Among the most emotionally distressing experiences in cardiac surgery is the removal of mediastinal drains. The study compared between two commonly used methods for pain control during the procedure of chest drain removal. We either used systemic administration of IV morphine or local infiltration of Bupivacaine as a mode of analgesia. Our goal was to provide effective analgesia and patient comfort, while keeping high standards of patient safety.</p></div><div><h3>Methods</h3><p>A prospective, randomized, single blinded observational study conducted in a single institution; Cardio-thoracic surgery Academy, Ain –Shams University, Cairo, Egypt. 70 Patients, with valvular heart lesions needing elective surgical intervention in the form of valve replacement/repair were enrolled in the study. On the day after surgery, when the mediastinal drains were no longer surgically needed, patients were randomized to one of two groups. In the first group (Morphine group, n = 35), patients received an IV bolus of 0.1 mg/kg morphine over a period of 2 min. The second group (Bupivacaine group, n = 35), received 0.5% bupivacaine as subcutaneous infiltration around the sites of drain insertion, using a standardized technique. Drains were removed 20 min later. All the patients had their blood pressure, heart rate and the pain score on a Visual Analog Scale (VAS) assessed 20 min before starting the procedure (baseline values), and were assessed one more time, 5 min after completion of the procedure (drain removal values).</p></div><div><h3>Results</h3><p>The median difference within the bupivacaine group between baseline and drain removal VAS scores was 19.94 ± 2.36 mm and 9.52 ± 2.41 mm respectively (this showed to be highly significant, P &lt; 0.001).</p><p>Median VAS scores difference between the bupivacaine and morphine groups on drain removal were 9.52 ± 2.41 mm and 18.93 ± 2.96 mm respectively (this showed to be highly significant, P &lt; 0.001).</p></div><div><h3>Conclusions</h3><p>There was a significant difference with regards to patients’ pain control between both groups. Concerning pain scores (VAS) reduction at post procedural point, a local subcutaneous infiltration of 0.5% bupivacaine is a superior analgesic modality.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 289-293"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.08.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88219069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular rings and slings: A challenging diagnostic and therapeutic rare disease entity","authors":"Y. Menaissy, Mohamed El-Gamal, S. Amin, Ahmed Zaki","doi":"10.1016/J.JESCTS.2017.10.002","DOIUrl":"https://doi.org/10.1016/J.JESCTS.2017.10.002","url":null,"abstract":"","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"45 1","pages":"349-355"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75836489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moderate versus deep hypothermic circulatory arrest for ascending aorta and aortic arch surgeries using open distal anastomosis technique","authors":"Ahmed Abdelgawad ,&nbsp;Heba Arafat","doi":"10.1016/j.jescts.2017.11.006","DOIUrl":"10.1016/j.jescts.2017.11.006","url":null,"abstract":"<div><h3>Background</h3><p>There are two common strategies for brain protection during aortic arch surgeries, deep hypothermic circulatory arrest (DHCA) with retrograde cerebral perfusion (RCP) and moderate hypothermic circulatory arrest (MHCA) with antegrade cerebral perfusion(ACP). They are hotly debated, although the superiority of the latter is shown. We, therefore, have adopted MHCA with ACP for reconstruction cases and compared the hospital outcomes for these two circulatory arrest management strategies prospectively.</p></div><div><h3>Methods</h3><p>From June 2015 to July 2017, a concurrent series of 43 patients (DHCA, 25; MHCA, 18) underwent ascending aortic ± aortic arch procedures for aortic aneurysm and dissection diseases using routine open distal anastomosis technique. The incidences of the three main types of operations performed (Bentall procedure (88.0% of DHCA vs 77.8% of MHCA), replacement (20% of DHCA vs 16.7% of MHCA) and interposition tube graft (12.0% of DHCA vs 16.7%of MHCA) did not reveal any statistical differences between the two groups. Similarly, rates of concomitant cardiac procedures (mitral valve repair and CABG, p-value of 0.664) were comparable.</p></div><div><h3>Results</h3><p>All demographics were similar. Of note the prevalence of aneurysm pathology (76.0% of DHCA vs 72.2% of MHCA, p-value of 0.779). Total operative time (306.60 ± 25.31 vs 281.56 ± 30.06 min, p-value of 0.005), CPB time (208.04 ± 30.04 vs 179.83 ± 45.47 min, p-value of 0.019) and aortic cross-clamp time (150.20 ± 26.15 vs 125.56 ± 39.20 min, p-value of 0.018) were significantly higher in the DHCA group. Overall perioperative transfusion requirements were significantly lower in the MHCA group (72.0% of DHCA vs 55.6% MHCA, p-value 0.000. Postoperative outcomes were similar. Hospital mortality was 16.0% and 16.7% in DHCA and MHCA respectively. Similarly, stroke and reoperation for bleeding were similar (8.0% of DHCA vs 5.6%of MHCA, p-value of 0.756). Again, renal failure requiring dialysis rate was 12.0% in the DHCA group compared to 5.6% of MHCA (p-value 0.473).</p></div><div><h3>Conclusions</h3><p>MHCA with ACP achieved very good and comparable results to DHCA with RCP for ascending and aortic reconstruction. Furthermore, MHCA significantly shortened total operative, cardiopulmonary bypass and ischaemic times and, basically, decreased transfusion requirements compared with the former strategy and consequently may lead to better patient's outcome.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 323-330"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.11.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85283664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early and midterm results of upper ministernotomy approach for aortic valve replacement","authors":"I. Moursi,&nbsp;K. Al Fakharany","doi":"10.1016/j.jescts.2017.11.001","DOIUrl":"10.1016/j.jescts.2017.11.001","url":null,"abstract":"<div><h3>Background</h3><p>Aortic valve replacement (AVR) surgery today offers excellent results with low morbidity and mortality. However, the evolution of surgery encourages us to develop minimally invasive techniques. We report in this study our early experience of AVR by Upper Ministernotomy and describe the surgical technique, learning curve, complications and surgical follow-up.</p></div><div><h3>Methods</h3><p>Between March 2009 and March 2013, 50 patients underwent surgery for AVR at Zagazig university hospitals by inverted T Upper Ministernotomy (mean age 48 ± 11.2). The mean Euro-SCORE was 5.7% ± 4.1 and the ejection fraction was 60% ± 12. Six patients had an associated ascending aortic replacement. The cannulation was performed in femoro-femoral by the direct or percutaneous approach.</p></div><div><h3>Results</h3><p>Mean aortic clamping time for patients with isolated AVR was 91 ± 29 min and bypass time of 123 ± 56 min. One patient required conversion to sternotomy. The mean duration of mechanical ventilation was 10.3 ± 26.3 h, the average length of stay in intensive care units was 2.6 ± 2.2 days, and the mean hospital stay was 9.3 ± 5.8 days. Hospital mortality was 2 patients (4%).</p></div><div><h3>Conclusions</h3><p>The Upper mini-sternotomy for aortic valve surgery is an approach that offers many benefits. However, it is technically more complicated and requires a learning curve beyond which it can offer a lower complication rate with lower pain, blood loss and transfusion, and rapid return to normal activities.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 311-315"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.11.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81222011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic amiodarone in patients with severe aortic stenosis and left ventricular hypertrophy undergoing aortic valve replacement: Silencing the rebels","authors":"Mohammed Abd Al Jawad ,&nbsp;Mohammed S. Shorbagy ,&nbsp;Mohammed Saleh","doi":"10.1016/j.jescts.2017.12.001","DOIUrl":"10.1016/j.jescts.2017.12.001","url":null,"abstract":"<div><h3>Background</h3><p>Ventricular fibrillation occurs commonly after aortic cross clamp in patients undergoing aortic valve replacement for severe aortic stenosis. Amiodarone is a class III antiarrhythmic drug that can be used as a prophylactic measure to prevent reperfusion ventricular fibrillation as ventricular fibrillation increases myocardial oxygen demand and hence myocardial damage.</p></div><div><h3>Methods</h3><p>A prospective, randomized, triple blinded study conducted in a single institution, Cardio-thoracic Academy, Ain –Shams University, Cairo, Egypt.120 patients with severe AS enrolled for elective aortic valve replacement. 60 patients received 10 ml of normal saline 9% (control group), while the other 60 patients received a single dose of Amiodarone 150 mg in 10 ml of Dextrose 5% through the pump circuit (Case Group). The incidence of post clamp arrhythmia, need of defibrillation, cardiac support was recorded.</p></div><div><h3>Results</h3><p>36 patients (60%) of the case group had spontaneous sinus rhythm upon declamping which is significantly lower than control group. The incidence of VF was lower in the case group (P value &lt; 0.001) (highly significant). The number of DC shock required for ventricular defibrillation, total bypass and declamping times were significantly lower in the case group.</p></div><div><h3>Conclusions</h3><p>Prophylactic use of a single dose amiodarone through the pump circuit before cross clamp release reduces the incidence of reperfusion induced ventricular fibrillation and subsequent defibrillation therapy needed.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 337-342"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.12.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82874518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bidirectional Glenn procedure with and without cardiopulmonary bypass: Short term results","authors":"Ahmed Deebis ,&nbsp;Ayman Gabal ,&nbsp;Mohamed Abdelsadek ,&nbsp;Ahmed Fadaly","doi":"10.1016/j.jescts.2017.07.006","DOIUrl":"https://doi.org/10.1016/j.jescts.2017.07.006","url":null,"abstract":"<div><h3>Background</h3><p>Bidirectional superior cavopulmonary anastomosis (BDG) is a palliative surgical procedure for anatomical or physiological univentricular hearts, in which the superior vena cava is anastomosed to the ipsilateral pulmonary artery in an end-to-side manner with or without cardiopulmonary bypass (CPB) support. The objective of this study was to compare the short term results of the BDG procedure performed on CPB or without CPB.</p></div><div><h3>Methods</h3><p>Between February 2015 and September 2016, 57 consecutive patients (mean age 33.27 ± 18.4 months) undergoing BDG were randomly assigned to either group I: using CPB (n = 27 patients; mean age 30.56 ± 16.47 months) or group II: without using CPB (n = 30 patients; mean age 23.96 ± 14.67 months). In group II two techniques were used <strong>(A)</strong> A temporary veno-atrial shunt were used (n = 15 cases mean age 23.3 ± 14.58 months), <strong>(B)</strong> without using veno-atrial shunt (n = 15 cases mean age 24.6 ± 15.24 months). We monitored the superior vena caval (SVC) pressure, O2 saturation, Operative time, mechanical ventilation period, intensive care unit (ICU) stay, hospital stay, operative mortality and postoperative complications.</p></div><div><h3>Results</h3><p>There was significant decrease in the operative time in group II (81.63 ± 14.83 min) in comparison to group I (122.33 ± 16.21 min). The differences in the period of mechanical ventilation, ICU stay &amp; hospital stay were insignificant. In addition, the differences between both groups as regard postoperative complications and mortality were insignificant.</p></div><div><h3>Conclusions</h3><p>The BDG procedure can be performed with no significant differences in operative mortality, morbidity, or use of resources, with or without CPB support.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 343-348"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.07.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Total arterial complete revascularization versus combined complete revascularization in patients undergoing coronary artery bypass grafting: Early outcomes","authors":"Ayman Sallam ,&nbsp;Elatafy E. Elatafy ,&nbsp;Mohab Sabry","doi":"10.1016/j.jescts.2017.11.008","DOIUrl":"10.1016/j.jescts.2017.11.008","url":null,"abstract":"<div><h3>Background</h3><p>Total arterial revascularization is a target to achieve in patients with coronary artery disease (CAD) especially in younger patients. This study sought to assess early outcomes after total arterial complete re-vascularization versus combined complete re-vascularization in patients undergoing coronary artery bypass surgery (CABG).</p></div><div><h3>Methods</h3><p>In a period of 12 months, a number of 104 successive patients subjected to on-pump isolated CABG (no other concomitant procedures) were included in our study. Those patients were divided into two main groups based on grafting strategy: Total arterial grafts “G1” (all arterial grafts no saphenous veins) and Left internal mammary artery (LIMA) in addition to saphenous vein grafts (SVG) “G2”.</p></div><div><h3>Results</h3><p>Complete arterial re-vascularization patients “G1”were younger, more often of male gender, better New York Heart Association (NYHA), less often operated upon urgently and more comorbid diseases without any significant difference. On the other hand, composite complete re-vascularization “G2” received more distal anastomosis than complete arterial re-vascularization patients “G1” without any significant difference.</p></div><div><h3>Conclusions</h3><p>Looking for the early results it may be difficult to get a significant difference between total arterial revascularization and composite arterial and venous grafting.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 331-336"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.11.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83894135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognosis of diabetic coronary artery bypass graft surgery patients","authors":"I. Moursi,&nbsp;K. Al Fakharany","doi":"10.1016/j.jescts.2017.08.007","DOIUrl":"10.1016/j.jescts.2017.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Diabetes mellitus (DM) is considered as mortality and morbidity risk factor for coronary artery bypass graft surgery (CABG). Studies revealed that there are controversies concerning the results of a post coronary surgery diabetic patients. The aim of our study was the evaluation of the short-term outcomes in this group of patients.</p></div><div><h3>Methods</h3><p>This was a single-center retrospective study of 180 patients that were subjected to CABG between January 2014 and January 2016 in Zagazig University Hospital, Zagazig, Egypt. Sixty-one patients (34%) were diabetic (group I) and 119 patients (66%) were non-diabetic (group II). During follow-up period the hospital mortality, complications and major cardiovascular events were analyzed. All patients admitted with a diagnosis of diabetes had an HbA1c ≥ 6.5% or fasting blood glucose (FBG) ≥ 126 mg/dL (7.0 mmol/L).</p></div><div><h3>Results</h3><p>Operative mortality was 3% (n = 2) in the diabetic group and 1% (n = 1) in non-diabetic patients (p = 0.3). Euro score was predictably higher in diabetic patients (1.2 vs 0.84, p = 0.001). The study of the risk factors associated with hospital complications revealed that the absence of diabetes was a protective factor for hospital complications but statistically insignificant. The rate of major cardiovascular events at 2 years period of follow-up in diabetic and non-diabetic groups was (12/50) 24% and (16/93)17%, respectively (p = 0.43).</p></div><div><h3>Conclusions</h3><p>The improvement in management of DM patients leads to acceptable operative mortality post-CABG and decrease the incidence of complications and events in the short-term follow-up period.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 294-300"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.08.007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77152468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-operative removal of chest tube in video-assisted thoracoscopic procedures","authors":"M. El-Badry, H. Elkhayat, Gamal A Makhlouf, A. Ghoneim","doi":"10.1016/J.JESCTS.2017.09.002","DOIUrl":"https://doi.org/10.1016/J.JESCTS.2017.09.002","url":null,"abstract":"","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"41 1","pages":"362-368"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82784075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}