Minimally invasive valve surgery Queen Alia Heart Institute experience

To assess the results of minimally invasive cardiac valve surgery at Queen Alia Heart Institute. The medical records and operative notes of 60 consecutive patients, who underwent minimally invasive valve surgery with or without other concomitant surgical cardiac procedures at Queen Alia Heart Institute between February 1997 and August 2003, were retrospectively reviewed. A satisfactory valve repair and/or replacement were performed in 58 cases through a minimally invasive approach. Conversion to classical midsternotmy was done in two cases [3.3%]. Mean incision length was 6 cm [rang 5-7]. Mean duration of operation, cardiopulmonary bypass, and cross clamp time was 150, 70, and 35 minute respectively. Mean duration of intensive care unit stay was 30 hours [range 24 to 36 hours] and mean duration o hospital stay was 4 days [range 3 to 5 days]. All patients were discharged from hospital. Postoperative wound infection and neurological deficits were not noticed All patients had a speedy recovery with less pain and trauma. At mean follow-up of 12 months [range 1 month to 1 years] all patients were alive and in NYHA functional class I. Minimally invasive valve surgery is technically feasible, safe and provides adequate exposure for valve repair and/or replacement in selected cases. It allows rapid recovery and early hospital discharge. Case selection an more technical experience are needed to further evaluate the early and long-term outcome of this procedure

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

Indigence of atherosclerosis in the left internal mammary artery selected for coronary artery bypass graft

In patients undergoing coronary artery bypass graft [CABG] surgery at Queen Alia Heart Institute, internal mammary grafts are the second most commonly used conduits for myocardial revascularization, i.e. saphenous vein grafts. This prospective study was designed to determine the incidence of atherosclerosis in the left internal mammary artery [LIMA]. Patients and Materials: In 100 consecutive patients undergoing coronary artery bypass graft a biopsy was taken from the distal left internal mammary artery. There were 95 males and 5 females with a mean age of 56.1 years. The presence of risk factors for atherosclerosis [smoking, diabetes mellitus, hypertension, hyperlipidemia and family history of coronary artery disease] was documented as well as other concomitant diseases. The atherosclerotic involvement of LIMA was classified histologically into grade 0,1,2 and 3. Grade 0 corresponds to normal artery without atherosclerosis, Grade 1 minimal intimal hyperplasia, Grade 2 lumen obliteration of less than 50% and Grade 3 lumen obliteration of more than 50%. Of the 100 LIMA specimens examined, five were found to have evidence of atherosclerosis. Only one patient had grade 3 atherosclerosis and was suffering from connective tissue disease on steroid therapy. The five patients were all males with ages ranging between 45-55 years. The atherosclerotic involvement of LIMA has not correlated to a constant risk factor. The internal mammary artery [IMA] is not immune but definitely has a lower incidence of atherosclerosis compared to the coronary arteries or other conduits used for CABG. We conclude that the incidence of IMA atherosclerosis in patients with coronary artery disease is low. The presence of clinically significant atherosclerosis in LIMA is difficult to predict. However, a routine angiographic evaluation of the LIMA is not warranted as a preoperative investigation. Furthermore no constant predictive risk factor for its atherosclerotic involvement could be found