Evaluating the potential effect of melatonin on the post-cardiac surgery sleep disorder

Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery [CABG]. Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score [GSQS], and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance [ANCOVA] and independent t-test were used to compare the sleep and anxiety scores between the groups. P values

Passion for life: lived experiences of patients after coronary artery bypass graft

Coronary artery bypass graft surgery [CABG] improves the quality of life, increases survival, and influences the patient's mental and emotional aspects. Little information is available on the lived experience of Iranian patients after this surgery. Understanding the lived experiences of patients will help health professionals with better provision of high quality care. This hermeneutic phenomenological study aimed to understand the lived experience of patients after CABG. Van Manen's method was used to conduct the study. A semi-structured, face-to-face interview technique was employed to explore the experiences of the patients following surgery. Seven men and 4 women between 49 and 80 years old were interviewed. Passion for life was the main theme extracted from the participants' interviews. This theme comprised the three sub-themes of receiving attention from family, being hopeful, and being spiritually oriented. The results showed that the participants experienced passion for life after their surgery. This finding reveals that patients tend to find a new perspective on life and their health after surgery

Central venous line and acute neurological deficit: a case series

Central venous catheter [CVC] insertion is a practical way to assess patients hemodynamic specially in cardiovascular surgery but this relatively simple junior level procedure is not risk free and its common reported complications include; pneumothorax, hydrothorax, hemothorax, local hematoma, cardiac tamponade, vascular injury, thrombosis, embolism, and catheter disruption. Here in this article we are going to present 6 patients with very unusual presentation of CVC complication which was neurological deficit presented by agitation, unconsciousness, disorientation to time and place and hemiparesis. All patients undergone neurologic consult and brain computed tomography. Final diagnosis was brain ischemic damage and finally we kept them on conservative management; fortunately we did not have any permanent damage

Percutaneous mitral valve repair with the edge-to-edge technique: case series of first Iranian experience

Mitral regurgitation [MR] is a common valvular lesion in the general population with considerable impact on mortality and morbidity. The MitraClip System [Abbot Laboratories, Abbot Park, IL, USA] is a novel percutaneous approach for treating MR which involves mechanical edge-to-edge coaptation of the mitral leaflets. We present our initial experience with the MitraClip System in 5 patients. In our series, the cause of MR was both degenerative and functional. Two patients received two MitraClips due to unsatisfactory results after the implantation of the first clip. Acute procedural success was seen in 4 patients. Blood transfusion was required for 2 patients. All the patients, except one, reported improvement in functional status during a 2-month follow-up period. Our initial experience with MitraClip implantation indicates that the technique seems feasible and promising with acceptable results and that it could be offered to a broader group of patients in the near future

Late diagnosis of large left ventricular pseudoaneurysm after mitral valve replacement and coronary artery bypass surgery by real-time three-dimensional echocardiography

One of the most serious complications of mitral valve replacement is left ventricular rupture and pseudoaneurysm formation, which is rare but potentially lethal. We herein present a late type of post mitral valve replacement and coronary artery bypass surgery pseudoaneurysm in a 74-year-old female, who was admitted to our hospital with a recent history of exertional dyspnea. She had the above-mentioned operation 10 months before. The diagnosis was made via two-dimensional and real-time three-dimensional transthoracic echocardiography. The prosthetic mitral valve was removed, and the large orifice of the pseudoaneurysm was closed by surgery. At one year's follow-up, the patient was in good condition

Knowledge management in cardiac surgery: the second Tehran heart center adult cardiac surgery database report

The Adult Cardiac Surgery Databank [ACSD] of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. There were 24959 procedures performed: 19663 [78.8%] isolated coronary artery bypass grafting surgeries [CABGs]; 1492 [6.0%] isolated valve surgeries; 1437 [5.8%] CABGs concomitant with other procedures; 832 [3.3%] CABGs combined with valve surgeries; 722 [2.9%] valve surgeries concomitant with other procedures; 545 [2.2%] surgeries other than CABG or valve surgery; and 267 [1.1%] CABGs concomitant with valve and other types of surgery. The overall mortality was 205 [1.04%], with the lowest mortality rate [0.47%] in the isolated CABGs and the highest [4.49%] in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males [1.90% vs. 0.74%, respectively]. Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD.

Screening of carotid artery stenosis in coronary artery bypass grafting patients

We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting. A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiac surgery at Tehran Heart center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 [81.48%] of these patients. The patients' age ranged between 20 and 84 years [mean: 58.33, SD: 10.08 years]. Of the 1604 patients studied, 1186 [73.9%] were men, 592 [36.9%] had diabetes, 598 [37.3%] were smokers, and 194 [12.1%] cases had significant left main stenosis. Twenty-one [1.3%] patients had significant carotid stenosis [> 60% stenosis], which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 [1.4%] of the patients without carotid stenosis. Magnetic resonance angiography [MRA] was conducted in 15 patients. In our univariate analysis, female gender [p value = 0.023], hypertension [p value 0.055], peripheral vascular disease [p value < 0.001], and age [p value = 0.001] were significant in the development of carotid stenosis. Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, .female gender, and advanced age