Evaluations of topical application of tranexamic acid on post-operative blood loss in off-pump coronary artery bypass surgery

One of the major complications of cardiac surgery is the presence of post-operative bleeding. The aim of the present study was to investigate the topical application of tranexamic acid in the pericardial cavity on post-operative bleeding in off-pump coronary artery bypass graft [CABG] surgery. This study was on 71 patients who underwent off-pump CABG. The anesthesia and surgery methods were the same for all patients. Patients were assigned to two equal groups. In the first group, 1 g of tranexamic acid in 100 mL of normal saline solution [NSS] was applied to pericardium and mediastinal cavity at the end of surgery. In the second group, only 100 mL of NSS was applied. Chest drainage of the patients after 24 h and the amounts of blood and blood products transfusion were also recorded during this time. Patients were the same regarding demographic information and surgery. The average volume of blood loss after 24 h was 366 mL for the first group and 788 mL for the control group. There was a statistically significant difference between the two groups [P < 0.001]. The amount of packed red blood cells transfusion in the first group was less than that of the control group, which was not statistically significant. There was no statistically significant difference between the amount of hemoglobin, hematocrit, platelets, prothrombin time and partial thromboplastin time in the postoperative stage in the two groups. The topical application of tranexamic acid in off-pump CABG patients leads to a decreased post-operative blood loss.

Transcatheter closure of atrial septal defect with amplatzer device in children and adolescents: short and midterm results; an Iranian experience

Transcatheter closure of secundum atrial septal defect [ASD] with Amplatzer device is an alternative procedure to surgical repair, with some limitations. The aim of this study was to assess the initial and mid-term results of the treatment of ASD with Amplatzer septal occluder in children and adolescents. From May 2003 to January 2008 sixty three consecutive children and adolescent patients underwent transcatheter closure of ASD at a mean +/- SD age of 8.5 +/- 4.8 years [range 2.2 to 18 years]. All procedures were performed under local anesthesia and moderate sedation or general anesthesia with transthoracic echocardiography and fluoroscopic guidance. Stretch diameter of ASD was determined by balloon sizing catheter. Device selection was based on and matched to the standard diameter of the septal defect. Follow up at 24 hours, 1 month, 6 months, 12 months and yearly thereafter included physical examination, electrocardiography and transthoracic echocardiography. The mean ASD diameter, measured with transthoracic echocardiography and balloon catheter were 19.5 +/- 5.5 mm and 20.9 +/- 6.2 mm, respectively. The mean follow up period was 32.4 +/- 18.8 months. Deployment of the device was successful in 57 [90.5%] and failed in 6 [9.5%] patients. The major complication included dislodgement of device in 1 patient and device embolization to right ventricular inlet [surgically removed] in 1 patient. The minor complication included transient atrial tachycardia in 10 patients, paroxysmal supraventricular tachycardia in 2 patients during procedure, successfully terminated with medication. At 24 hour, 1 month, 6 month and 1 year follow up, total occlusion rates were 73.6%, 91%, 94.7%, and 94.7%, respectively. Transcatheter occlusion of ASD with Amplatzer device is an effective and safe procedure with minimal complication rate and short hospital stay, as well as excellent short and intermediate outcome in children and adolescents

Perioperative predictors and clinical outcome in early and late ICU discharge after off-pump coronary artery bypass surgery

The duration of ICU [intensive care unit] stay in cardiac surgery patients has an important role in the rate of complications and costs. The aim of this study was to determine the role of perioperative risk factors in clinical outcome based on the time of ICU discharge. In this descriptive study, 219 patients undergoing off-pump coronary artery bypass [OPCAB] surgery in Afshar Hospital in Yazd, an Iranian city, were divided into early [24 hrs] ICU discharge groups according to the duration of ICU stay. The preoperative, intraoperative and postoperative risk factors, the complications and the outcome were evaluated. Age, sex, hyperlipidemia, diabetes mellitus, previous myocardial infarction, renal failure, cerebrovascular accident, and level of hematocrit and creatinine were not significantly different between the two groups. Patients with hemodynamic instability, respiratory dysfunction, ejection fraction <35%, hypertension, inotrope administration, left main coronary artery involvement, use of intraaortic balloon pump [IABP] and arrhythmia had significantly higher mortality and longer ICU stay [>24 hrs] compared to others [P value <0.05]. The duration of intubation was significantly lower in the early discharge group [7.8 +/- 3.8 hrs compared to 17 +/- 9.9 hrs] than in the late discharge group. Time of ICU discharge depends on perioperative risk factors, and risk factor modification may improve clinical outcome

Clinical outcome and cost in patients with off-pump vs. on-pump coronary artery bypass surgery

General concept and major emphasis on off-pump coronary artery bypass surgery [OPCAB] is maintaining quality of care and patient safety while reducing cost and resource utilization. OPCAB probably avoids the potential complications of cardiopulmonary bypass. However its acceptance depends on clinical and economic outcome. The aim of this study is to compare clinical and economic outcome of off-pump and on pump coronary artery bypass surgery. This is a report of an analytic cross-sectional study on 304 patients underwent coronary artery bypass surgery that were randomized into conventional on pump and off-pump groups. Variables and costs were obtained for each group and these data were analyzed using parametric methods. There was no difference between the two groups with respect to perioperative and intraoperative patient's variables. OPCAB reduced the need for postoperative transfusion requirement [P<0.05] which was statistically significant and showed a trend towards reduction of morbidity although didn't reach statistical significance [P>0.05]. There were no statistically significant differences in surgical re exploration and length of stay between the two groups. The mean cost for an on pump surgery was 8312000 +/- 2859 Rials per patient that was significantly higher than an off-pump surgery. Based on the findings of this study, clinical outcome has no statistically significant difference between on pump and off-pump CABG but the costs are significantly higher in the on pump group

[Tracheo-innominate artery fistula as a late onset tracheotomy complication: a case report]

Tracheo-innominate artery fistula [TIF] is a rare, life threatening and catastrophic complication, which may occur 7 to 14 days after surgery. The Incidence Rate of TIF is 0.1-1% and survival rate of patient is 14.3%. Herein, we describe TIF in a patient 50 days post tracheotomy, based on our research, it appears that our case is the first finding with the latest onset of TIF after tracheotomy, which now has been improved by early diagnosis and surgical treatment