Mid-term results of the lateral tunnel operation at Queen Alia heart institute

To determine midterm results of univentricular repair using intra-atrial lateral tunnel at Queen Alia Heart Institute. Between January 1999 and January 2005, 159 patients [99 males, 60 females] underwent either a fenestrated or non-fenestrated lateral tunnel [Fontan procedure], for a wide range of complex congenital heart disease with a functional single ventricle at Queen Alia Heart Institute. Median age at operation time was 3.8 years [range 1.5-17 years]. Multiple factors were analyzed including: anatomical variations, mean right atrial pressure, pulmonary artery pressure, ventricular end diastolic pressure, aortic saturation, cardiopulmonary bypass time and ischemic time, presence of arrhythmias, pacemaker insertion, thromboembolic complications, early and late mortality. The major anatomic diagnosis was double inlet left ventricle in 72 patients [45.3%] and the least was unbalanced complete atrioventricular septal defect among 8 patients [5%]. Dextrocardia was found in 17 patients. The mean right atrial pressure was 8 +/- 3 mmHg, pulmonary artery pressure 13 +/- 2.6 mmHg, PVR 1.9 +/- 2 Woodunits.m2, ventricular end diastolic pressure 14 +/- 2.2 mmHg, aortic saturation 83 +/- 4%, cardiopulmonary bypass time 121 +/- 9 minutes, ischemic time 47 +/- 3 minutes. Early postoperative supraventricular tachyarrhythmia [SVT] occurred among 10 cases [6.3%] of patients, in whom four needed antiarrhythmic drugs before discharge. Early bradyarrhythmia needing pacemaker in 2 patients [1.26%], whereas 6 patients needed pacemaker at mid term follow-up. There were 10 [6.3%] early deaths and no late deaths occurred after 6 years of follow-up. Seven [4.7%] patients developed protein loosing enteropathy as a late complication and 7 more patients [4.7%] developed neurological complications. Proper selection of patients for the lateral tunnel Fontan procedure results in excellent early and mid-term survival and functional outcome with low incidence of complications

Vacuum-assisted closure technique fastens the healing of deep sternal wound infection

To compare the Vacuum-Assisted Closure technique to the conventional wound management in the treatment of patients with deep sternal wound infection after cardiac surgery. A total of 4400 patients underwent open heart surgery at Queen Alia Heart Institute between July 2001 and July 2005.Thirty six patients developed poststernotomy deep sternal wound infections [0.8%].These patients were treated by two different modalities. Twenty patients [group I] were treated by the conventional wound management. The other [group II] 16 patients were treated by Vacuum Assisted Closure Technique. The two groups were comparable with regards to age, sex, weight, associated diseases, presenting postoperative day, infecting organism, and risk factors for deep sternal wound infection. Patients treated by Vacuum Assisted Closure [group II] had a lower mean duration treatment time 10.5 days while the mean duration treatment time was 32 days in group I .Mean hospital duration stay was 17.6 days in group II, however it was 40 days in group I. Mean long term follow up period of both groups was six [range 2-14] months. Re-admissions and repeated surgical procedures was 30% in group I and 12.5% in group II. Perioperative mortality was higher in group I [10%] than in group II [6.25%]. The Vacuum-Assisted Closure Technique for deep sternal wound infection management has many advantages over conventional methods. Vacuum Assisted Closure offers the benefits of an optimal physiological environment of closed technique and the efficient removal of necrotic debris seen with the open technique. Moreover, Vacuum Assisted Closure shortened wound healing and hospital stay, cost-effective, and safe

use of bovine jugular vein in the fontan circulation

To report our experience n the use of bovine jugular vein [Contegra] in the completion of single ventricle repair. This is a prospective study on a selective group of single ventricle patients who underwent total cavopulmonary connection at Queen Alia Institute between July 2002 and April 2003. All patients had cardiac catheterization preoperatively. Pressure measurements were taken at different points before and after the procedure. All patients had an extracardiac connection on cardiopulmonary bypass without cross clamp and anticoagulated using heparin infection postoperatively for at least 5 days. Five patients were enrolled in the study [2-5 years of age], chest tubes drainage were minimal. Hospital stay was between 1-2 weeks. There were no evidence of conduit thrombosis, arrhythmias or mortality at three months of follow up. Contegra is a safe extracardiac conduit for the completion of single ventricle repair in selected group of patients. Its use is time sparing intraoperatively and decreases hospital stay and morbidity postoperatively. However, its use in a wider range of complex single ventricle patients needs to be evaluated

Sternal wound complication following upper midsternotomy incision. the experience at Queen Alia Heart Institute

To assess wound-related complications in patients undergoing open-heart surgery through minimally invasive approach, and to assess an alternative safer access to standard sternotomy. Over 30 months period ninety patients underwent elective open heart surgery via upper sternotomy incision risk factors for wound infection. Sternal wound complications were classified according to the seriousness and the extent of wound infection. Patients were followed-up for one month after hospital discharge. Of the 90 patients, 73 [81%] were males and 17 [19%] were females. Age ranged between 19-72 years [mean 40 years]. The procedures performed were valve surgery, coronary artery by-pass grafting and septal myomectomy in 86 [95.6%], 2 [2.2%] and 2 [2.2%] patients, respectively. Simple wound dehiscence occurred in 2, superficial wound infection in 6. None had deep wound infection or sternal wound dehiscence. One patient died from prosthetic valve endocarditis without sternal wound complications. Upper median sternotomy significantly reduces the serious complication of sternal wound closure and hence the hospital stay of the patients as well as the utilization of the medical resources