Anaesthetic thchniques and early extubation in cardiac surgical patients

Aim of the Work: To study the efficacy of early extubation either in the operative room [OR] or in the intensive care unit [ICU] within six hours postoperatively

Patients and Methods: Hundred consequetive cardiac patients admitted to cardiac surgery at the National Heart Institute [NHI] were included in the study to evaluate early tracheal extubaon in both the operative room [OR] and the intensive care unit [ICU]

Results: Fourty eight patients were extubated in the OR, 13 of them were reintubated in the ICU either due to unsatisfactory blood gases, low cardiac output or surgical bleeding necessitating transfer to the OR. There were other 48 patients who could be extubated within 6 hours in the ICU, 10 of them were reintubated. The remaining 6 patients showed delayed recovery due to liver affection and were extubated after 6 hours but within 24 hours from termination of surgery

Conclusion: Early tracheal extubation can be achieved without morbidity or mortality in the majority of adult cardiac surgery patients

LITA-LAD revascularization without cardiopulmonary bypass

Two male patients with post-infarction angina and positive exercise test were submitted to left Internal Thoracic Artery-Left Anterior Descending corollary artery [LITA-LAD] without cardiopulmonary bypass [CPB]. Their ages were 43 and 47 years. The angiographic lesion was total obstruction of the left anterior descending artery that was visualized retrogradely from septal branches of PDA of right coronary artery. Their blood groups was A2B Rh-ve and O Rh-ve. The two cases were done as first case in day and CPB was in stand-by with clear fluid priming to be used for the second case in day. The exposure of the LAD was as usual and the LITA-LAD anastomosis was done using 7/0 Prolene. The immediate postoperative course was smooth, no blood transfusion was used, no perioperative myocardial infarction. Patients were extubated after 8 and 9 hours and discharged from ICU in 24 hours. In hospital control showed complete disappearance of the anginal pain, no new Q wave in resting ECG, CK level was within normal and no new abnormal wall motions by echocardiography. This technique has the advantage to avoid using CPB that may cause cerebral, pulmonary and renal complications, no blood transfusion, least heparin and protamine use, smooth postoperative course, early extubation and low cost wise

Mitral valve replacement with preservation of valve leaflets and chordae tendineae

Forty patients with chronic mitral valve disease underwent mitral valve replacement [MVR] at the National Heart Institute, Imbaba in a prospective study to compare between MVR with and without preservation of valve leaflets and chordae tendineae, to study the influence of preservation of parts of the MV apparatus on immediate and early postoperative course of left ventricualr [LV] function. The patients [pts] have been divided into two groups: group I [20 pts] had MVR with preservation of the MV apparatus while group II [20 pats] had conventional MVR. Preoperative, operative and postoperative data are reviewed for both groups with follow up for 6 months. Patients of group l showed easier weaning off bypass, shorter stay in ICU and hospital, and better preservation of IV function early postoperatively when compared to patients of group II. We conclude that MVR with preservation of the MV apparatus is more economic to patient and hospital, and decreases morbidity and mortality duo to better preservation of LV function postoperatively

Late results of valve replacement experience of the National Heart Institute Imbaba Cairo Egypt

A randomized retrospective study of 5 years follow up of all valve replacement of a series inserted in The National Heart Institute has been done to evaluate the late results of such a procedure. Between January 1st 1984 and December 31st 1988 a total number of 958 valve prosthesis were inserted in 685 patients, The immediate post-operative mortality is 46 patients [6,71%] of different causes. This work concerns the long term results of the 639 patients discharged from hospital after the post-operative period. A follow up of these patients between 32 months and 81 months [mean period of 47,23 months] showed that 496 pts are living [survival rate: 77,62%]. None of the patients of this series were lost to follow up. Out of the 496 pts, 322 pts have improved post-operatively the quality of their life; 82 pts are living postoperatively in stage II NYHA and 92 in stage III NYHA living on digitalo-diuretic therapy and vasodilators. The pre-operative state of the heart, the quality of myocardial protection which were standardized in all patients of the series and the wall stress of LV played an important role in post-operative results. Out of the 143 dead patients, 82[57,34%] died of anticoagulation problems, 23 pts [16,08%]from endocarditis, 6[4,19%] from aseptic detachment of prosthesis; 10 [6,99%] valve prosthesis dysfunction; 22 [15,38%] the cause of death is unknown. No haemolysis occurred as a late complication. Apart from the Wessex and the Ionescu valve prosthesis, there was no significant difference between the different prostheses used in this series. From the above results one may conclude, that valve replacement is not the ideal treatment. All efforts should be directed to preserve the patients native valve as long as possible. anticoagulation problems and endocarditis are the main complications of valve replacement in Egypt. Well selected patients for valve replacement improve considerably the post-operative functional results