Beta-blocker therapy in coronary artery bypass surgery: our experience at Queen Alia heart institute

The objective of the study was to look at the effect of using beta-blockers perioperatively in patients undergoing coronary artery bypass graft surgery at Queen Alia Heart Institute This is a retrospective analysis of all patients who underwent coronary artery bypass graft surgery between April 2005 and September 2006 at Queen Alia Heart Institute. The data collected included the patients demographic characteristics, risk factors for coronary artery disease, history of myocardial infarction, renal dysfunction, history of prior cardiac surgery and the nature of coronary artery disease. We assessed operative mortality, rate of stroke, atrial or ventricular arrhythmias, duration of ventilatory support and Intensive Care Unit stay. Inclusion criteria were adult patients who were admitted for coronary artery bypass graft surgery, excluding patients who had valvular surgery, aneurysmectomy and off pump bypass surgery. We had a total of 916 patients. Four hundred and ten patients were on beta-blockers while the rest were not. The two groups did not differ in their characteristics. The mean age was 60.0 +/- 11 years, with 24% females. The mean Intensive Care Unit stay was 1.8 +/- 0.5 days for the 13-blockers group and 2.0 +/- 0.6 days for the non-beta-blockers group [P=0.001]. Patients who had beta-blockers had a rate of atrial or ventricular arrhythmias of 26% compared to 38% in the non-beta-blockers group [P=0.001]. The mean post-operative hospital stay for patients who received 13-blockers was 7.2 +/- 3 days compared to 8.4 +/- 3.2 days in the non-beta-blockers group [P<0.001]. In-hospital mortality was 4.2% in the beta-blockers group and 5.3% in the non-beta-blockers group [P=NS]. Stroke was seen in 2.1% in the first group compared to 3.3% in the non-13-blockers group [P=NS]. Ventilatory support for more than 24 hours was seen in 7.1% compared to 6.9% in the non-13-blockers group [P=NS]. Intra-Aortic Balloon Pump support was used in 4.9% compared to 5.2% in the non-beta-blockers group [P=NS]. Perioperative beta-blockers use is associated with significantly lower incidence of arrhythmias, shorter hospital stay and non-significant lower in-hospital mortality. They had no effect on ventilatory support or the use of intra-aortic balloon pump support

Vacuum-assisted closure technique fastens the healing of deep sternal wound infection

To compare the Vacuum-Assisted Closure technique to the conventional wound management in the treatment of patients with deep sternal wound infection after cardiac surgery. A total of 4400 patients underwent open heart surgery at Queen Alia Heart Institute between July 2001 and July 2005.Thirty six patients developed poststernotomy deep sternal wound infections [0.8%].These patients were treated by two different modalities. Twenty patients [group I] were treated by the conventional wound management. The other [group II] 16 patients were treated by Vacuum Assisted Closure Technique. The two groups were comparable with regards to age, sex, weight, associated diseases, presenting postoperative day, infecting organism, and risk factors for deep sternal wound infection. Patients treated by Vacuum Assisted Closure [group II] had a lower mean duration treatment time 10.5 days while the mean duration treatment time was 32 days in group I .Mean hospital duration stay was 17.6 days in group II, however it was 40 days in group I. Mean long term follow up period of both groups was six [range 2-14] months. Re-admissions and repeated surgical procedures was 30% in group I and 12.5% in group II. Perioperative mortality was higher in group I [10%] than in group II [6.25%]. The Vacuum-Assisted Closure Technique for deep sternal wound infection management has many advantages over conventional methods. Vacuum Assisted Closure offers the benefits of an optimal physiological environment of closed technique and the efficient removal of necrotic debris seen with the open technique. Moreover, Vacuum Assisted Closure shortened wound healing and hospital stay, cost-effective, and safe