Acute renal failure after cardiac surgery

Acute renal failure [ARF] following cardiac surgery occurs in 1 to 10% of patients. Patients who develop ARF have higher rates of mortality. This study was undertaken to estimate the role of perioperative variables in predicting of post cardiac surgery ARF. We studied a cohort of 398 adult patients who underwent cardiac surgery at our institution from February 2004 to February 2006. Adult patients who were scheduled for cardiac valvular surgery, coronary artery bypass grafting [CABG] or both, with or without cardiopulmonary bypass [CPB] were included. Exclusion criteria were death within two days of operation [n = 8], incomplete patient data, and preexisting renal dysfunction and dialysis requirement or a baseline serum creatinine > 4 mg/dl. Age, sex, left ventricular ejection fraction, diabetes, preoperative, presence of proteinuria [on dipstick], type of surgery, use of CPB and duration of surgery were recorded. A logistic regression analysis was performed to assess independent contribution of variables in the risk of ARF. A binary logistic regression revealed age was an independent predictor of ARF [P < 0.05]. When both preoperative and intraoperative variables were included in a multinominal logistic regression model, preoperative proteinuria independently predicted ARF [Odds ratio= 3.91, 95% CI: 1.55-9.91, P = 0.004]. Our results revealed that special considerations should be given to elderly and patients with proteinuria when managing post cardiac surgery ARF

Early results of median sternotomy versus right anterolateral thoracotomy in atrial septal defect closure

Atrial septal defect [ASD] closure by surgery is a standard method with low mortality and complication rate. Nowadays, surgeons prefer to use less invasive methods including interventional and limited thoracotomy. The aim of this study was to compare the post surgical results in two groups undergoing ASD surgery, by sternotomy or thoracotomy method. This retrospective study was performed in Shahid Madani heart hospital from 1998-2003 on 73 patients who underwent ASD surgery. Data were collected by filling out a questionnaire. Group I [thoracotomy] included 38 patients with mean age of 23.84 +/- 3.2 years and group II [complete sternotomy] included 35 patients with mean age of 21.82 +/- 2.3 years. The results were almost the same in both groups except for longer operation time [p=0.01] and shorter hospitalization period [p=0.01] in group I. Considering lower injury by surgery and better cosmetic results, ASD repair by thoracotomy seems to be a suitable method