Aspirin resistance in patients undergoing coronary artery bypass grafting

Aspirin is a very common drug used after coronary artery bypass grafting. Significantly it is known to reduce mortality and the rate of ischemic complications after CABG. Resistance to Aspirin is a well known entity and has a great influence on clinical outcome. Our study will investigate the phenomenon of aspirin resistance in our patients that underwent coronary artery bypass surgery. In a prospective controlled study 100 patients undergoing coronary artery bypass grafting [CABG] were included to investigate their sensitivity to Aspirin using platelets aggregometry study. Patients were followed up after one year to show their clinical outcome. 25 patients [25%] showed normal reaction to Aspirin [sensitive to treatment]. 24 patients [24%] were preoperatively resistance to Aspirin and 51 patients [51%] developed this resistance postoperatively. The use of cardiopulmonary bypass, pump time and type of procedure showed no influence on the resistance rate. The one year follow up showed 5 deaths in the group of patients that developed the resistance preoperatively whereas resistance disappeared completely after one year in the perioperative resistant group. Aspirin resistance occurs in a large portion of patients that undergo open heart surgery for coronary artery bypass grafting. It doesn't appear to last permanently but rather for a brief period. The worse outcome for patients with Aspirin resistance could be assumpted by the increase mortality in this group

Hydatid cyst of the left ventricle of the heart

The present study involves a 47-year-old male patient from Jordan that presented with a history of progressive shortness of breath and chest tightness. Cardiac hydatidosis was diagnosed based on typical radiological findings and a positive serology test. Intra-operatively, there was a mass of a hydatid cyst located in the left ventricle and interventricular septum with no other organs involved. The patient was treated by a surgical excision and albendazole without any complications

use of recombinant activated factor VIIa in the management of post operative bleeding in cardiac surgery; our experience at Queen Alia heart institute

To describe our experience in the use of recombinant activated factor VII [Novoseven] in the management of post operative bleeding in cardiac surgery at Queen Alia Heart Institute / King Hussein Medical Center-Jordan. A simple descriptive study at Queen Alia Heart Institute between January2008 till December 2011 on a total of 160 patients who underwent open heart surgery and received recombinant activated factor VII [rf VIIa] was conducted. A specially designed medical record abstract form was used to collect demographic, surgical and hematological data. Simple descriptive statistics [mean, percentage, interquartile range] was used to describe the relevant data. T-test was used also for determining bleeding, transfusion and coagulation profile before and after rfVIIa treatment. P value was considered statistically significant if <0.005. The rate of recombinant factor VIIa use was 0.02% [number of patients received Novoseven/ total number of operations carried out]. The mean dose of rfVIIa used was 65microg/kg where 152 patients [95%] of the study group received single dose that stopped their bleeding. A total of 135 [84%] patients received their dose in the Intensive Care Unit while 25 patients [16%] received their dose in the operating theater. After the administration of recombinant factor VIIa it was clear that the amount of blood loss significantly decreased and the usage of the blood and its products was appreciably lower with the therapy than before it [p<0.001]. Clinical outcome showed 4 deaths among patients received Novoseven [2.5% mortality rate] although this was expected because of previous risky preoperative or intraoperative course. None of our patients developed thromboembolic complications. Recombinant Factor VIIa appears to be safe and effective in controlling nonsurgical life threatening bleeding in cardiac surgery. It has been able to decrease the amount of blood loss, restoring hemostasis and reduce the need for further blood transfusion

effect of skeletonization of the left internal thoracic artery on rates of sternal wound infection: experience at queen alia heart institute

To study whether skeletonization of the internal thoracic artery has any beneficial effects on the rate of sternal wound infection after Coronary Artery Bypass Surgery and to compare this with the results of the classical pedicled form. A total of 212 patients were reviewed between October 2005 and February 2006 and divided into two groups according to the method of harvesting the left internal thoracic artery. Group I comprised 158 patients, 102 males and 56 females with a mean age of 59 +/- 2 years. Group II comprised 54 patients, 41 males and 13 females with a mean age of 57 +/- 2 years. In group I, the Left Internal Thoracic Artery was harvested in the classical pedicle form [preserving the vasa vasorum, venous drainage] using cautery and clips. In group II another method of harvesting was adopted using forceps and scissors and depriving the Left Internal Thoracic Artery from all the accompanying structures. The overall rate of sternal wound infection was 9.5% in Group I and 3.7% in group II [P<0.05].In Group I, 10 males and five females were infected [males 9.8% and females8.9%] while in group II only two male patients were infected. Harvesting the Left Internal Thoracic Artery in the skeletonized form takes longer time and is more difficult to do due to our developing learning curve; nonetheless it has a beneficial effect on decreasing the rate of sternal wound infection. The overall outcome was improved but other issues such as the overall patency and post operative pain should be studied more thoroughly

Does the application of negative suction to the chest drains increase the rate of mediastinal bleeding after coronary artery bypass graft?

There is controversy whether the institution of negative suction for cases of Coronary Artery Bypass Surgery [CABG] affects the rate of Mediastinal bleeding. Consecutive cases of CABG were studied according whether negative suction was applied [Group A] or not [Group B] from October 2003 till May 2004. The 24 hour blood loss, mortality rates, re-opening for bleeding and post-operative pericardial effusions were analyzed. 281 consecutive cases of CABG alone or in combination with other procedures were studied. Negative suction was applied in 78 cases [28%]. Male-to-female ratio was 3.2:1. Pure CABG was done in 92% of the cases. Concomitant procedures included Mitral valve repair and replacement and Aortic valve replacement. Re-do surgery was performed in 16 cases [5.6%]. Left Internal Thoracic Artery [LITA] was utilized in 81%. Average blood loss in group A was 870 +/- 270 ml and group B 630 +/- 215 ml giving a P value<0.05. Re-opening for bleeding occurred in 10 cases in group A [12.8%] and 9 cases in group B [4.4%] with a P value >0.05. There were 11 deaths overall [3.9%] 4 in group A [5.1%] and 7 in group B [3.4%]. Pure CABG had 7 deaths from a total of 258 cases; a mortality rate of [2.7%]. Pericardia! effusion occurred in 2 cases in group A [2.5%] and 9 in group B [4.4%] giving a P value > 0.05. Despite the limitation of not being a randomized study, nonetheless, it shows that negative suction applied to the chest drains after CABG increase Mediastinal drainage but had no effect on reopening rates, pericardial effusion and overall mortality

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