Cost-effectiveness of intraoperative transesophageal echocardiography in cardiac valve surgery

Being a unique diagnostic technique, transesophageai echocardiography [TEE] has influenced many different aspects of cardiac surgery including valve repair surgery. The cost-effectiveness of this method however is questioned considering the conditions of every region and country. In this study we aimed at answering the question if utilizing TEE throughout valve repair surgery could be cost-effective. Twenty four patients were studied within two groups of case "valve repair operation plus intra-operative TEE [10-TEE]" and control [valve replacement operation]. Variables including age, gender, left ventricle ejection fraction [LVEF], re-operation, intensive care unit [ICU] stay, hospital stay and cost were studied and compared. There was no significant difference regarding age, gender and LVEF between two groups [p=0.559, p=0.413, and p=0.408, respectively] ICU stay in repair group was less than replacement group [p=0.009]. Hospital stay difference however was not statistically significant [p=0.928]. The cost of valve repair under 10-TEE monitoring was significantly less than valve replacement [p=0.00l]. 10-TEE not only would assist surgeons by increasing their interest toward valve repair operation instead of replacing impaired cardiac valves but also consequently decrease hospital costs. It is also advised for the cardiac anesthesiologists to use 10-TEE routinely in the valve repair operations provided that there are no contraindications

Causes and risk factors for chest reexploration after coronary artery bypass grafting surgery

To determine causes and risk factors for chest reexploration after coronary artery bypass grafting surgery [CABG]. In a retrospective study, the medical records of 105 patients that had chest reexploration CABG surgery from 2004 to 2006 in Madani Heart Hospital were assessed. Frequency of reexploration was 105 1904 [5.5%]. In addition, the records of 195 patients without chest reexploration that randomly selected from 1799 patients, were assessed,the medical records of patients were studied regarding demographic characteristics, causes and risk factors of chest reexploration. Data analysis was conducted by SPSS software using descriptive and inferential statistics. The findings indicated that most frequent causes for chest reexploration were bleeding [36.2%] and cardiac tamponade [30.5%]. In addition, risk factors for chest reexploration were weight and body mass index [BMI] of patient, preoperative PT value, and preoperative use of Plavix. Reexploration rate in this study was close to other studies results

neonate with berry syndrome [AP window with interrupted aortic arch]

Full term neonate patient, about 3 kg weighs, admitted in child hospital because of Respiratory distress syndrome [RDS]. Investigation by echocardiography reveled large aorto-pulmonary window [AP window] with sever coarctation of aorta. Findings at the time of operation were large AP window and interrupted aortic arch with patent ductus arteriosus [Berry syndrome]. The anomalies corrected at the same operation. Unfortunately sever acidosis; brain and pulmonary edema, not responding to medical therapy contribute to patient's death

Intravascular catheter colonization and related bloodstream infection in Madani Cardiac Surgery Center

Venous and arterial catheters are used ordinary for continuous hemodynamic evaluation in cardiac surgery intensive care units. The catheters are one of the most important risk factors for nosocomial infection and mortality of hospitalized patients. The aim of this study was to evaluate the rate of bacterial colonization of intravascular catheters and catheter related bloodstream infection in Shahid Madani intensive care unit. 150 admitted patients that had intravascular catheter for more than 48 hours were enrolled in this study during one year period the tip segment of catheters and insertion site cultures were assessed. The rate of colonization was 13[8.7%]. the isolated bacteria were Escherichia coli [23.1%], Pseudomonas aeruginosa [23.1%] staphylococcus aureus [7.7%], coagulase negative staphylococcus [7.7%], Proteus vulgaris [7.7%], Stenotrophomonas maltophilia [7.7%], Candida albikans [7.7%], nonfermentative gram negative bacilli [7.7%] and Acinetobacter spp [7.7%]. The rate of catheter colonization was acceptable in comparison to the other studies. The most common isolated bacteria were Escherichia coli and Pseudomonas aeroginosa. In this study, the important risk factors were duration of catheter use, duration of hospitalization and positive blood culture

relationship between cerebral oxygen saturation changes and post operative neurologic complications in patients undergoing cardiac surgery

To study the relationship between cerebral oxygen saturation changes and postoperative neurologic complications. Seventy two adult patients with ASA class II, III who were scheduled for elective cardiac surgery, were randomized into three groups: Group I: with CPB [on-pump] Group II: without CPB [off-pump] Group III: valve surgery. Neuropsychological outcome was assessed by the Mini-Mental State Examination [MMSE]. Cerebral oxygen saturation was also measured. There was no statistical difference in desaturation of more than 20% among three groups [P=0.113] but it was significant between group I and II [P=0.042]. Changes of rSO2 in different hours of surgery was significant in group I and group II [P=0.0001 in both] but it was not significant in group III [P=0.075]. Although cerebral oximetry is a noninvasive and useful method of monitoring during cardiac surgery, it has low accuracy to determine postoperative neurologic complications