Pre-operative carotid doppler ultrasound scanning among patients who underwent cardiac surgical procedures at Queen Alia Heart Institute, is it necessary?

To assess the frequency of significant carotid artery disease among the study group patients who underwent cardiac surgical procedures and highlight the importance of pre-operative Carotid Duplex Ultrasonography Scanning. This is a descriptive study which was conducted on a consecutive series of 102 Jordanian patients who underwent cardiac surgical procedures at Queen Alia Heart Institute between January and December 2009, and were pre-operatively examined for carotid artery disease. Median age of the study group patients was 63 [range 40-78] years, there were 84 males and 18 females, 76[74.5%] were hypertensive, 62[60.7%] diabetics, 67[65.6%] had history of smoking, 45[44%] had a Body Mass Index >30, 13[12.7%] had significant left main disease. Ten patients [9.8%] had a pre-operative history of transient ischemic attack or cerebrovascular accident. Chi-square was used to determine significance of the study variables, P value<0.05 was considered significant. Seventeen patients [16.6%] were found to have 50% or greater stenosis of one or both carotid arteries whereas for an 80% or greater stenosis; it was 6[5.8%]. Frequency of a 50% or greater stenosis of one or both carotid arteries was 3[6.5%] in patients between age 60 and 69 years, increasing to 11[42.3%] for patients age of 70 years and older. Independant risk factors for the presence of >50% stenosis in one or both carotid arteries in this group of patients were a previous history of transient ischemic attack or cerebrovascular accident, left main coronary disease, hypertension, history of smoking. Among 4 patients found to have concomitant significant carotid lesions and were hemodynamically stable with no critically stenotic coronary arteries, management was staged, carotid stenting was performed as a first stage in 2 patients and carotid endarterectomy was performed as a first stage in another 2 patients, cardiac procedures were performed successfully as a second stage in these 4 patients. Concomitant significant Carotid Artery Disease among the study group patients above the age of 70 who underwent cardiac procedures is relatively high, selective pre-operative Carotid Duplex Ultrasonography should be mandatory

Reopening for bleeding after adult cardiac surgery

To determine the frequency and effects of post operative bleeding among adult cardiac surgery patients at Queen Alia Heart Institute. The medical records, operative and post operative notes of 1000 adult patients who underwent open heart surgery [coronary artery bypass grafting, valvular, ascending aorta and arch repair, and others] between January 2008 and April 2009 were retrospectively reviewed, 45 of them were reopened for bleeding. During the study period, 1000 patients underwent open heart surgery 45 [4.5%] of them underwent reopening for bleeding; 37 [82.2%] were males and 8 [17.7%] females. The average age for those operated upon was 63 years, with an average Body Mass Index of 27.66. The total pump run time was in the range of [54-220] minutes, with an average of 111.89 minutes. 25 [55.5%] patients showed a surgical cause for bleeding, while 19 [42.2%] showed a non-surgical cause. All cases were reopened in the operating theatre except for 1 [2.22%] who had to be reopened in the Intensive Care Unit. The most common cause of surgical bleeding was conduit related, in the form of a slipped ligature or avulsed branch occurred in 6 [13.3%] patients, followed by bleeding from the Left Internal Mammary Artery bed occurred in 5 [11.1%] patients. The most common non surgical cause was related to preoperative medications, Asprin and Plavix [Clopidogrel] being the most common [13.3%], followed by Low Molecular weight Heparin [11.1%]. The average ICU stay was 3.5 in comparison to 2 days for those not reopened, and the total hospital stay was in average 11.5 in comparison to 6 days for those not reopened. Post reopening Atrial fibrillation happened in 8 [17.7] patients and sternal complications in 8 [17.7%] and were the most common morbidities, followed by pleural and pericardial effusions, renal impairment, Intensive Care Unit delirium and psychosis, 2 [4.4%] patients died. Post operative bleeding in cardiac surgery is a serious complication with an increase in both morbidity and mortality. Thus extra care should be taken intraoperatively to limit surgical causes of bleeding, in addition to encouraging policies that promote early return to the operating theatre for exploration once the criteria for reopening have been met