The effect of weight loss on the outcome after coronary artery bypass grafting in obese patients.

The role of body mass index (BMI) in the setting of coronary artery bypass graft (CABG) surgery has been a focus of past studies. However, the effects of postoperative weight loss in patients after CABG is yet to be known. We performed a retrospective study of 899 patients who underwent CABG at our institution. Perioperative patient information was collected from an onsite electronic record system. Patients were grouped into four BMI categories: normal controls, overweight, obese and morbidly obese. Based on the postoperative BMI changes, patients were then grouped into three categories: gainers, no change and losers. Statistical analyses were performed using analysis of variance and linear regression to establish an association among the data. Hazard ratios (HR) and cumulative survival were obtained by the Cox-Mantel and Kaplan-Meier analyses, respectively. The normal controls exhibited a markedly higher mortality postoperatively, at 27.9%, especially when compared with the obese individuals (16.1%). Patients who lost weight faced a significantly increased risk of mortality than those who experienced no changes or gained weight after surgery. This trend was especially salient among the obese patients, who more than tripled their mortality risk (HR = 3.24) versus individuals who gained weight, and more than doubled their risk (HR = 2.87) versus those who had no changes. We conclude that obesity confers a survival advantage in the setting of the CABG surgery. Weight loss among all BMI categories of patients studied results in an adverse effect on postoperative survival.

Valve sparing aortic root reconstruction in acute dissection of the ascending aorta

Acute dissection of the ascending aorta requires immediate surgical intervention. Use of the reimplantation technique in patients with severe aortic insufficiency remains controversial, in this study we assessed the feasibility and outcome of the valve-sparing aortic root re-implantation technique in patients with severe preoperative aortic insufficiency. Between April 2005 and March 2008, 19 patients with acute aortic dissection of the ascending aorta [Stanford type A] underwent valve sparing aortic root reconstruction. Their ages ranged from 24 to 76 years [51.7 +/- 13.2, 58% males]. Transesophageal echocardiography was carried out for diagnosis of disease, left ventricle ejection fraction and valve insufficiency. Length of hospitalization, echocardiographic and clinical follow-up, complications and mortality were analyzed. Four patients [21%] died of non-valve-related complications. Major complications after operation were seen in three patients [15.8%]. Mean length of stay in the intensive care unit [ICU] was nine days, and the mean duration of hospitalization were 16 days. Comparison of pre- operative and post-operative clinical profiles of patients showed that left ventricle ejection fraction and seventy of aortic insufficiency were significantly altered [P<0.05]. Comparison of patients who survived with those who died showed that only cardio pulmonary bypass time had statistically significant difference [P=0.04]. Valve sparing aortic root reconstruction in patients with type A dissection can be performed with acceptable intra-operative mortality and morbidity and excellent results during follow-up

Prevalence and risk factors of mortality after surgery for congenital heart disease in Tabriz, Iran: a five year retrospective analysis

The mortality rate after surgeries for congenital heart disorders is the most important factor for determination of the quality of these operations. A study that evaluate the mortality rate of these surgeries has not been done till now in Iran. Therefore, the purpose of this study was to determine the prevalence and risk factors of mortality after surgery for correction of congenital heart disease. In a retrospective study, 120 children who expired after cardiac surgery and also 150 children who survived after surgery were evaluated between 2005 and 2009. Personal and Social parameters and some risk factors were analyzed. Analysis of results was performed using SPSS version 14 and descriptive and inferential statistics. It showed that 12.64% of children died after surgery. Important risk factors of death were age, weight, height, body surface, preoperative Blood Urea Nitrogen, preoperative Prothrombin Time, preoperative cyanosis and postoperative bleeding. The results of this study indicate that the death rate of children after heart surgery in cardiovascular center of Tabriz Medical University seems to be high. Because of the lack of studies in this field more trials are advised