Ceftriaxone prophylaxis in cardiovascular surgery in children.

Fifty patients undergoing closed and open heart surgery were prospectively studied for the effectiveness of peri-operative prophylaxis with Ceftriaxone. Twenty-four patients (Gr I) that underwent closed heart surgery received 50 mg/kg single dose of Ceftriaxone given intravenously at the start of anesthesia. Twenty-six patients (Gr II) that underwent open heart surgery received 50 mg/kg. Ceftriaxone given intravenously at the start of anesthesia followed by another 50 mg/kg 24 hours later. The mean duration of surgery in Gr I was 1.7 hours and Gr II was 4.2 hours. The duration of post-operative fever in Gr I ranged from 0-4 days (mean 2.4) and Gr II ranged from 1-13 days (mean 6). The duration of post-operative hospitalization in Gr I ranged from 5-18 days (mean 9) and Gr II ranged from 7-71 days (mean 19). Early and late infectious complications were not found in Gr I. Late infectious complications were not found in Gr I. Late infectious complications in Gr II consisted of 2 cases of pneumonitis, 5 pleural effusions and 1 staphylococcus aureus would infection (36.8%). We concluded that a single dose of Ceftriaxone should provide adequate prophylaxis for closed heart surgery. An additional 2-3 days of daily dose Ceftriaxone may be needed when associated with tissue hypoxia, longer duration of intravenous lines and drainage tubes in open heart surgery.

Six years clinical experience with dura mater cardiac valves.

Homologous dura mater bioprostheses have been used for over 6 years in 217 patients who hae undergone cardiac valve replacement at Chulalongkorn Hospital and Medical School, Bangkok. The mitral valves were replaced in 151 patients (69.6%), aortic valve replacements were performed in 29 patients (13.7%), and multiple valve replacement were performed in 37 patients (16.7%). This study will be confined mainly to the isolated mitral and aortic valve replacements. The early deaths in the mitral replacement series was 10.5%, and 13.8% in the aortic valve replacement. Myocardial (pump) failure was the cause of early death in the majority of cases. The late mortality was 7.3% in the mitral position and 12.0% in the aortic position. The mean improvement of NYHA class was from 3.76 to 1.13 in the mitral series, and from 3.64 to 1.32 in the aortic group. The actuarial survival rates at 6 years after operation were 87% and 84% respectively and compare favorably with several prostheses currently in use. There was no case of thromboembolism even though no anticoagulants were used.