Impact of blood transfusion on troponin I levels and outcomes after cardiac surgery: a cohort study

Objectives: Increased cardiac troponin I [TI] has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective cardiac surgeries

Methods: We conducted a retrospective review of 542 patients. Patients were divided into two groups based on TI levels at 24 hours [TI24] [> 6.5 microg/L vs.

Results: Red blood cell [RBC] transfusion was found to be associated with high TI levels [odds ratio [OR] = 2.33, p = 0.007, 95% confidence interval [CI]: 1.30–4.30]. A trend was observed when aortic cross-clamp time and preoperative ejection fraction were adjusted for [OR = 2.06, p = 0.080, 95% CI: 0.90–4.70]. An association was found between aortic cross-clamp time and high TI levels in the multivariable model [OR = 1.01, p = 0.028, 95% CI: 1.00–1.02]. Elevated TI levels was associated with higher mortality [OR = 4.15, p = 0.017, 95% CI: 1.29–13.08], renal failure [OR = 2.99, p = 0.004, 95% CI: 1.41-6.32], and increased length of stay in-hospital [OR = 4.50, p = 0.020, 95% CI: 0.69-8.30]

Conclusions: RBC transfusion is associated with increased TI24 post-cardiac surgery and worse outcomes, albeit a confounding effect cannot be excluded. Larger studies are required to confirm these findings

First implementation of transfusion consent policy in Oman

Objectives: transfusions are a common medical intervention. Discussion of the benefits, risks and alternatives with the patient is mandated by many legislations prior to planned transfusions. At the Sultan Qaboos University Hospital [SQUH], Muscat, Oman, a written transfusion consent policy was introduced in March 2014. This was the first time such a policy was implemented in Oman. This study therefore aimed to assess adherence to this policy among different specialties within SQUH

Methods: the medical records of patients who underwent elective transfusions between June and August 2014 were reviewed to assess the presence of transfusion consent forms. If present, the consent forms were examined for completeness of patient, physician and witness information

Results: in total, the records of 446 transfused patients [299 adult and 147 paediatric patients] were assessed. Haematology patients accounted for 50% of adult patients and 71% of paediatric patients. Consent was obtained for 75% of adult and 91% of paediatric patients. The highest adherence rate was observed among adult and paediatric haematology specialists [95% and 97%, respectively]. Consent forms were correctly filled out with all details provided for 51% and 52% of adult and paediatric patients, respectively. Among inadequately completed forms, the most common error was a lack of witness details [20-25%]

Conclusion: in most cases, the pre-transfusion consent policy was successfully adhered to at SQUH. However, further work is required to ensure full compliance with the consent procedure within different specialties. Implementation of transfusion consent in other hospitals in the country is recommended

White coat hypertension and masked hypertension among Omani patients attending a tertiary hospital for ambulatory blood pressure monitoring

Our study aimed to estimate the rate of white coat hypertension [WCH] and effect, and masked hypertension in patients attending a tertiary care hospital for 24 hour ambulatory blood pressure monitoring [24-h ABPM]. A total of 231 adult patients were referred to the Department of Clinical Physiology at Sultan Qaboos University Hospital, Muscat, for ABPM, between January 2010 and June 2012. The following data were gathered and analyzed: demographic data, clinic blood pressure [BP] measurements, and 24-h BP profile from ABPM. Thirty-two patients were excluded and the final analysis included 199 patients. There were 105 [52.8%] women and 94 [47.2%] men studied. The mean age of patients was 46 +/- 15 years and most patients were overweight with a mean BMI of 29.6 +/- 5 kg/m[2]. Around half of patients [53.8%] were on one or more antihypertensive medications. WCH was found in 10.6% and white coat effect was found in 16% of patients. The majority of patients [57%] with WCH were aged 40 years or above. Masked hypertension was present in 6% of patients and masked uncontrolled hypertension in 8.5% of patients. Our study showed that WCH and effect, and masked hypertension are common in hypertensive patients. Identifying these patients will have an impact on their management. However, the results of the study should be interpreted within the context of its limitations. Prospective randomized community and hospital-based studies should be conducted to estimate the true prevalence in the general population as well as in hypertensive patients

Pretreatment with hydroxyurea of the patient with essential thrombocythemia followed by coronary artery bypass surgery

The risk of thrombosis is high in patients with essential thrombocythemia. Special precaution needed for those patients who will undergo Coronary artery bypass grafting. We are reporting a 62 years old patient with ischemic heart disease who was found to have essential thrombocythemia. This report explains the preoperative management and the postoperative risks anticipated due to the treatment

[Open] approach to aortic arch aneurysm repair

Aortic arch aneurysm is a relatively rare entity in cardiac surgery

Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task

The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge

However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery

Literature has shown the advantage of selective cerebral perfusion techniques in comparison with only circulatory arrest. Ability to perfuse the brain has allowed circulatory arrest temperatures at moderate hypothermia without the need for deep hypothermia

Even though cannulation site selection appears to be a minor issue, literature has shown that the subclavian/axillary route has the best outcomes and that femoral cannulation should only be reserved for no access patients. Although different techniques for arch anastomosis have been described, we routinely perform the distal first technique as we find it to be less cumbersome and easiest to reproduce

In this review our aim is to outline a systematic approach to aortic arch surgery

Starting with indications for intervention and proceeding with approaches on site of cannulation, approaches to brain protection with hypothermia and selective cerebral perfusion and finally surgical steps in performing the distal and arch vessels anastomosis

Effect of preoperative aspirin on blood lossand blood transfusion in patients undergoingcoronary artery bypass grafting: Impactof discontinuation prior to surgery

The aim of our study is to evaluate the impact of recent aspirin use before CABG on the post operative bleeding, blood transfusion and re-exploration. Retrospectively collected data from 67 patients who were operated in Sultan Qaboos University Hospital from 2008-2009 was included in this study. Patients were divided into two groups, [1] Aspirin stopped >7 days before surgery [34 patient] and [2] Aspirin received within 7 days before surgery [33 patients]. Platelet transfusion and length of hospital stay was more in patients where Aspirin stopped < 7 days [P value 0.03 and 0.002 respectively]. There was trend of increase in intraoperative bleeding and PRBC transfusion in the group who received Aspirin within seven days. Postoperative blood loss was higher in aspirin users than non aspirin users but not statistically significant. There was no difference between two groups regarding re-exploration or operative mortality. Patients who take aspirin within 7 days before surgery have more tendency to have post-operative bleeding and receiving blood products. They also have longer length of stay in the hospital. Our recommendation is to stop aspirin more than 7 days before surgery

Off-pump coronary artery bypass grafting through left antero-lateral thoracotomy [thora-cab] - case report and review of literature

We report the first case of off-pump complete myocardial revascularization through antero-lateral thoracotomy [Thora-CAB] in Middle-East. 69 year old gentleman having angina pectoris for last three years with severe double vessel disease involving the left anterior descending artery [95% proximal lesion] and the circumflex system [80% mid circumflex lesion with significant osteal disease in obtuse marginal] and insignificant disease in right coronary artery with moderate left ventricular impairment underwent Thora-CAB, Post-operatively, he had minimal pain, quick symptomatic improvement and no complications. He was discharged home on 5th post-operative day. This indicates that the thoracotomy approach is safe and practical for CABG. It is well tolerated hemodynamically with no/minimal post-operative morbidity

Subclinical sickle cell crisis during cardiopulmonary bypass timely detection and early management

Sickle cell crisis can occur during cardiopulmonary bypass for cardiac surgical procedures in patients with sickle cell hemoglobin, which could lead to hemolysis. There is a dearth of such reports from the Arab world. We hereby present two cases from Oman with subclinical sickle cell crisis during cardiopulmonary bypass. The timely detection and early management resulted in good outcome. The good clinical practice for management of such patients is also discussed

Tuberous sclerosis in children

Thirteen children [7 females and 6 males] with tuberous sclerosis are reported. The mean age of presentation was 6 years with a range of 14 months - 12 years. Seizures were the mode of presentation in all the patients. All patients had skin lesions. Mental retardation was seen in 70% of the cases while cardiac involvement was observed in 3 cases. Family history was positive in only two cases