ABSTRACT
Background: hepatitis B and C are becoming a common occurrence in patients who are admitted for major surgical procedures and associated with significant morbidity and mortality. We evaluated the prevalence of hepatitis B and C admitted for different procedures in the cardiac surgery ward in relation to their postoperative recovery
Patients and Methods: one hundred and twenty six patients admitted during July to December 2007, 23.8% [n=30] were found to be seropositive. Data of 23 patients were available 65.2% [n=15] were male. The mean age of the subjects was 41 years, 56.5% [n=13] were seropositive for hepatitis B whereas 43.5% [n=10] for hepatitis C., 26% [n=6] had deranged preoperative LFT's. Post operatively 6 patients [26.1%] developed abnormal LFTs. Poor left ventricular function was present in 2[8.7%] patients, hypertension was present in 17.4%[n=4], 1 patient[4.3%] was Diabetic and obese, 2 patients[8.6%] have creatinine level more than 2 mg/dl
Results: the overall mortality was only 8.7% [n=2]. Altogether 60.9% [n=14] patients developed morbidities that comprised of: arrhythmias 13%[n=3], re-exploration 30.4%[n=7], wound dehiscence 4.3%[n=1] and in 10 cases [43.5%], morbidities other than these were seen that included: cardiac tamponade, disorientation, cough with hematemesis, infective endocarditis, renal failure, raised BP, delayed chest wound healing with persistent fever, bone pain and failure of saphenous graft. The mean time for bypass; 87 min and time for x-clamp; 58 min, 52% [n=12] patients needed inotropic support postoperatively with mean duration of 15 hrs. mean extubating time was 9.3 hrs. whereas mean time for removal of drain was 30.28 hrs. Bleeding recorded at 6hrs was 515 ml, at 24hrs; 903 ml and 422 ml on 2nd POD. The mean duration for ICU stay came out to be 3 days and ward stay was 4 days
Conclusions: * Approximately ¼ of the patients admitted during the 6 months period came out to be seropositive for hepatitis B and hepatitis C. * The number of affected males was greater than females. * Incidence of hepatitis B was greater than hepatitis C. * Practice of getting shave or hair cut from street barbers and needle prick injuries were popular source of infections particularly for hepatitis B virus, whereas blood transfusion and previous surgery got more response among hepatitis C seropositive. * Morbidity and mortality were high among these patients * Awareness regarding the above among general population and doctors should be created via public mass education
ABSTRACT
Intra aortic balloon pump [IABP] is the commonest used assisted device in cardiac surgery. Our aim is to investigate the effectiveness of therapy in our setup of patients, where poor ejection fraction, diffuse coronary artery disease and left main stem lesions are common. Retrospective study where 1296 patients underwent isolated CABG surgery for the period from Jan 1997 to Dec. 2003. 48 [3.7%] patients needed insertion of IABP perioperatively or early postoperatively. The early mortality rate in those who required IABP was 35% [17] of patients mean age of the patients was 56 +/- 4 years, 36 [75%] patients have preoperative myocardial infarction [MI] within week before surgery, 39 [81%] patients were diabetic. Chronic renal failure was present in 4 [8%] patients, COPD was present in 2 [4%], poor left ventricular function [less than 30%] was present in 36 [75%] patients, 41 [85%] patients were male. 65% [31] of patients who developed sever myocardial depression at the conclusion of surgery survive and discharge home. Significant improve in hospital survival in those patients who otherwise died warn us liberal use of IABP. High risk patients with low cardiac out put after operation, patients with low ejection fraction, recent MI and peri or postoperative MI benefit most with IABP. Insertion of IABP is simple and easily available assisted devise
ABSTRACT
Objective: To analyze the survival prognosis in patients with left main stem coronary artery lesion after surgical revascularisation [CABG] in first two years
Patients: Between August 2000 and August 2002, 30 patients [27 men and 3 women] were operated for left main stem coronary artery lesion. Mean age was 55.97 years. Preoperatively 28 patients presented with angina pectoris. The majority of the patients [93.3%] belonged to the New York Heart Association class III. Mean EF was 37%. Significant four-vessel disease was present in 7 patients [23%], triple vessel disease occurred in 21 patients [70%] and double vessel disease in 2 patients [7%]. Significant co-morbid factors included hypertension [80%], diabetes mellitus [43%], and smoking [23.3%]. All the patients were operated as an emergency. Average grafts per patient were 3.1. All patients were considered for LIMA, selection being based upon the severity of symptoms, left ventricular function, and suitability of the coronary vessels for grafting. LIMA was used to perform a bypass for LAD in 24 patients
Results: Operative mortality, defined as death within 30 days of surgery, was 6.66%. Two out of total three deaths occurred while within the hospital postoperatively. After 2 years of follow-up only one more death was observed [3.33%]. All three deaths were linked to coronary conditions. Among the survivors 96.29% [26 out of 27 patients] remained asymptomatic after two years. Only one patient reported shortness of breath and was categorized under angina class I of New York Heart Association
Conclusion: Our observations suggest that post CABG survival prognosis in patients with left main stem coronary artery lesion appears very good after two years of follow-up