ABSTRACT
Objectives: To study the effect of perioperative factors on patients' recovery after cardiac surgery in adults
Methods: This is a prospective observational analysis of 101 adult patients [age range 19-78 years] who had undergone coronary artery grafting, heart valve[s] replacement / repair or combined [coronary and valve] surgeries, was conducted at Queen Alia Heart Institute. The influence of 22 perioperative parameters [age, gender, co-morbidities, body mass index, type of surgical procedure, left ventricular function, cardiopulmonary bypass time [CPB], inotropic support, analgesia, postoperative blood losses,...] on recovery variables [time of extubation, ICU and hospital discharge] was studied. European system for cardiac operative risk evaluation [EUROSORE] has been calculated. Univariate and multivariate analysis of results was performed
Results: Mean time of mechanical ventilation was 11 +/- 8.5 hours. Delay in extubation was noticed in patients with left ventricular impairment, chronic respiratory disease, morbid obesity, urgent surgery, age above 61 years, patients who had reopening for control of bleeding and lower temperatures during deliberate hypothermic cardiopulmonary bypass. The mean length of ICU stay was 1.8 +/- 1.2 days. The average length of hospitalization was 5.1 +/- 1.2 days. There was a correlation between Length of intensive care unit stay and CPB [p-value=0.02], and between Length of intensive care unit stay and aortic cross clamp time [p-value=0.006]. Prolonged operative time [OT] was associated with increased length of hospitalization [p-value=0.008]. Average EUROSCORE value was 1.4 [ranged between 0.5 -5.3]
Conclusion: Left ventricular dysfunction, urgent surgery, inotropic support, considerable postoperative bleeding, morbid obesity, longer cardiopulmonary bypass and aortic clamp times, are main risk factors of delayed [or prolonged] extubation, and ICU/ hospital discharge
ABSTRACT
Primary antiphospholipid syndrome is an autoimmune coagulation disorder associated with recurrent arterial and/or venous thrombotic events and the presence of antiphospholipid antibodies. Echocardiography studies have disclosed heart valve abnormalities in about third of patients with primary antiphospholipid syndrome. Valvular lesions associated with antiphospholipid antibodies occur as valve masses [nonbacterial vegetations] or thickening. Both can be associated with valve dysfunction. The predominant functional abnormality is regurgitation, stenosis is rare. The mitral valve is mainly affected, followed by the aortic valve. Antiphospholipid antibodies often inhibit phospholipids dependent coagulation in vitro and interfere with laboratory testing of hemostasis. Therefore, the management of anticoagulation during cardiopulmonary bypass can be quite challenging for those patients. Here, we present a case of mitral valve replacement due to severe mitral regurgitation in a young patient with primary antiphospholipid syndrome