On-pump versus off-pump CABG: Study of platelet activation

Coronary revascularization on a beating heart avoids many of the side effects of cardiopulmonary bypass. Off-pump coronary bypass surgery offers an excellent chance to examine the impact of the surgery and the relatively high dose of heparin on platelet functions without using cardiopulmonary bypass. Sixty patients with coronary artery disease were prospectively randomized to [1] on-pump CABG with conventional cardiopulmonary bypass and worm cardioplegic arrest and [2] off-pump CABG on the beating heart. Platelet studies including bleeding time, platelet count, mean platelet volume, platelet aggregation using ADP and surface expression of P-selectin and Annexin-V using flow cytometry as markers of platelet activation. Platelet studies revealed definite platelet dysfunction in the on-pump group, however there was still statistically significant elevation of markers of platelet activation in the off-pump group. Platelet activation occurs in coronary bypass surgery even when CPB is no: used. This may correlate with previous reports of thrombotic complications of OPCAB surgery

Bicuspidization versus segmental annuloplasty in tricuspid valve repair

The tricuspid valve remains a challenge to the surgeons despite statements to the contrary. Although modern techniques have significantly reduced the mortality and morbidity of tricuspid repair, its indications remain controversial. Some surgeons recommend replacement, others repair, and some even suggest that the valve be ignored. This study was carried out to evaluate and compare bicuspidization repair [1st group] and segmental annuloplasty [2nd group] in repair of functional tricuspid regurgitation and to assess performance of tricuspid valve following these two techniques. During this study, fifty patients underwent tricuspid valve surgery for repair of functional tricuspid valve regurgitation secondary to rheumatic mitral with or without aortic valve pathology, in the period between November 2000 and December 2002 in The Department of Cardiothoracic Surgery, Kasr Al Aini Hospital, Cairo University. In all patients, left sided lesions [mitral with or without aortic valve lesion] were corrected during the same surgical procedure before tricuspid valve repair using mitral valve repair or replacement [for mitral valve lesions]; or aortic valve replacement for Aortic Valve Lesions. In all patients, tricuspid valve repair was performed. Patients were randomized into two groups 1st group [no. 25] included patients who underwent bicuspidization repair of their functional TR; whereas 2nd group [no: 25] included patients who underwent segmental annuloplasty for repair of their functional TR. Of the 50 patients operated upon in this study, 25 patients had bicuspidization and the other 25 had segmental annuloplasty for repair of their significant moderate to severe functional tricuspid incompetence secondary to rheumatic left sided valvular pathology. Both groups had preoperative and postoperative clinical, laboratory, electrocardiographic, radiographic and echocardiographic evaluation, 3 and 6 months after discharge from hospital. No mortality occurred in any of our patients. Tricuspid valve competence was restored in nearly 80% of all cases with only mild residual tricuspid insufficiency in about 20% of patients in the immediate postoperative period. Follow up after 3 and 6 months revealed recurrence of moderate tricuspid insufficiency in 4 patients [16%] in the l st group and 5 patients [20%] in the 2 nd group with no statistically significant difference between both groups. The simplicity of the two techniques, their efficacy and relative durability justifies their use in repair of functional tricuspid insufficiency at time of correction of left sided valvular lesions. We recommend using such simple repair techniques to correct pure functional moderate to severe tricuspid regurgitation in association with the left sided valve corrective procedures to ensure easy post operative recovery and decrease the risk of reoperation. However we recommend follow up of such patients for a longer period of time to confirm the efficacy and durability of such procedures and find out the incidence of recurrence of severe tricuspid regurge and the incidence of reoperation

Neuro-psychological changes after open heart surgery

This is a prospective study on 67 consecutive randomly selected cases of different open heart operations. There were 52 males [77.6%] and 15 females [22.4%]. 36 patients [53.4%] had surgery for RHD, 19 [18.4%] for CHD, 11 IHD [16.4%], and one case of Bental's operation [1.45%]. Three cases had intraoperative mortality, two cases has immediate postoperative mortality, and 6 had late postoperative mortality, and 6 had late postoperative mortality, with a total mortality of 11 cases [16.4%]. Neurologic complications [NC] were reported in 11 cases [16.4%] [5/11 with clinical proof of neuropsychiatric complications [NPsC] and 6/11 with severe neurological insult ending in mortality which did not allow psychological assessment]. On the other hand, 4 cases reported pure psychiatric complications [PsC] [5.9%]. So, the total incidence of psychiatric complications with or without neurological involvement was 9 cases [14.5%] while the total incidence of neurological, psychological or both types of complications was 15 cases [22.4%]. The following risk factors were found to predispose to the incidence of neurological complications: Among the preoperative factors, patients with RHD were found to be more affected than CHD and IHD. In the intraoperative factors, abnormal blood gases before bypass, prolonged total pump time, high mean blood pressure during bypass above 91.9 mmHg, low mean blood pressure during bypass less than 41.4 mmHg, significant operative accidents, and difficulty in wearing from heart lung machine. As regards, the postoperative factors; low postoperative mean blood pressure less than 61.6 mmHg, significant postoperative events, abnormal postoperative blood gases, abnormal postoperative acid base status, and abnormal regain of consciousness