Predicting outcomes in patients with low ejection fraction undergoing coronary artery bypass graft.

Introduction: Reduced left ventricular ejection fraction (LVEF) is a well-known predictor of adverse events after cardiac surgery. We aimed to assess the outcomes in patients with low LVEF undergoing coronary artery bypass graft. Methods: In this retrospective cohort, we included all patients with left ventricular ejection fraction ≤ 40 who underwent coronary artery bypass grafting between March 2007 and March 2016 (with a median follow-up of nine years) at Tehran Heart Center. Demographics and clinical characteristics were extracted from the data registry. Akaike information criterion (AIC) was used. The univariate Cox regression was performed. We investigated the predictors of mortality and major adverse cardiac and cerebrovascular events (MACCE) using Cox multivariable regression. Results: In total, 5,532 cases (79 % male) with a mean age of 65.58 were included in the study. The nine-year overall survival was calculated at 68 %, and more than half of the patients had MACCE (55 %). In adjusted multivariable Cox regression analysis, moderate to severe mitral valve regurgitation, glomerular filtration rate ≤ 60, mild right ventricular dysfunction, and valvular heart disease independently predicted higher mortality. The abovementioned predictors and peripheral vascular disease significantly increased MACCE. Conclusion: Our study indicates the clinical significance of mitral regurgitation, valvular heart disease, and renal function in patients with low ejection fraction treated by coronary artery bypass grafting surgery. Identifying predictors of adverse events can help with clinical decision-making and risk stratification, ultimately improving patient outcomes.

Comparing long-term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran.

Background: Hypertrophic cardiomyopathy (HCM) affects millions of individuals worldwide. In severe cases, it can cause life-threatening conditions such as left ventricular outflow tract (LVOT) obstruction, mitral regurgitation (MR), and sudden cardiac death, making surgical treatment necessary. This study aimed to report the long-term outcomes of HCM patients undergoing septal myectomy or mitral valve replacement (MVR) and compare the results between different types of surgeries. Methods: This was a retrospective cohort study on HCM patients who underwent surgical treatment in an Iranian referral center between 2005 and 2021. Patients were divided into three groups according to the type of surgery received: septal myectomy, MVR, or a combination of both surgeries. Patient characteristics, surgical and echocardiographic features, and in-hospital and long-term outcomes were reported and compared between the three groups. Results: A total of 102 patients with an average age of 53.3 ± 16.9 were included. Twenty-six patients had septal myectomy, 23 had MVR, and 53 had combined septal myectomy and MVR surgery. All surgeries were associated with a significant reduction in interventricular septum thickness and LVOT gradients. After a median of 6.8-year follow-up time, patients with an isolated septal myectomy had significantly lower mortality and major adverse cardiac and cerebrovascular events rates than the other groups. Conclusion: Isolated septal myectomy showed better long-term survival rates and can correct HCM-related MR, while MVR should be preserved only for intrinsic valve defects. More extensive studies are needed to confirm these findings and achieve a comprehensive guideline on surgical treatment of HCM.

Heart surgery over two decades: what we have learned about results and changing risks.

OBJECTIVES: Using the cardiac surgery database is of high importance in referral centers and can lead to a better quality of care for patients. Tehran Heart Center (THC) is a cardiovascular referral center that was inaugurated in 2001. In this report, we aimed to present the third report of trends in patients' cardiovascular risk factors and surgical procedures from 2002 to 2021 that have been gathered for all THC patients. METHODS: This serial cross-sectional study was conducted at Tehran Heart Center from 2002 to 2021. All patients undergoing cardiac surgeries were eligible to enter the study (N = 63,974). Those with miscellaneous types of surgeries were excluded (N = 9556). The distribution of cardiac surgeries (including isolated coronary artery bypass graft (CABG), isolated valve, and CABG + valve surgeries) and their respective in-hospital mortality were recorded. Furthermore, 20-year trends in the prevalence of various cardiovascular risk factors (CVRFs) among the following groups were evaluated: a) isolated CABG, b) aortic valve replacement/repair for aortic stenosis (AS/AVR/r), and c) isolated other valve surgeries (IVS). RESULTS: A total of 54,418 patients (male: 70.7%, age: 62.7 ± 10.8 years) comprised the final study population, with 84.5% prevalence of isolated CABG. Overall, the AS/AVR/r group was in between the CABG and IVS groups concerning CVRFs distribution. Excluding some exceptions for the AS/AVR/r group (in which the small sample size (N = 909) precluded observing a clear trend), all studied CVRFs demonstrated an overall rising trend from 2002 to 2021 in all three groups. Regarding in-hospital mortality, the highest rate was recorded as 4.0% in 2020, while the lowest rate was 2.0% in 2001. CONCLUSIONS: Isolated CABG remained the most frequent procedure in THC. Notable, increasing trends in CVRFs were observed during this 20-year period and across various types of cardiac surgeries, which highlights the clinical and policy-making implications of our findings.

Advanced micro-/nanotechnologies for exosome encapsulation and targeting in regenerative medicine.

Exosomes, a subset of vesicles generated from cell membranes, are crucial for cellular communication. Exosomes' innate qualities have been used in recent studies to create nanocarriers for various purposes, including medication delivery and immunotherapy. As a result, a wide range of approaches has been designed to utilize their non-immunogenic nature, drug-loading capacity, or targeting ability. In this study, we aimed to review the novel methods and approaches in exosome engineering for encapsulation and targeting in regenerative medicine. We have assessed and evaluated each method's efficacy, advantages, and disadvantages and discussed the results of related studies. Even though the therapeutic role of non-allogenic exosomes has been demonstrated in several studies, their application has certain limitations as these particles are neither fully specific to target tissue nor tissue retainable. Hence, there is a strong demand for developing more efficient encapsulation methods along with more accurate and precise targeting methods, such as 3D printing and magnetic nanoparticle loading in exosomes, respectively.

Robust Assembly of Cross-Linked Protein Nanofibrils into Hierarchically Structured Microfibers.

Natural, high-performance fibers generally have hierarchically organized nanosized building blocks. Inspired by this, whey protein nanofibrils (PNFs) are assembled into microfibers, using flow-focusing. By adding genipin as a nontoxic cross-linker to the PNF suspension before spinning, significantly improved mechanical properties of the final fiber are obtained. For curved PNFs, with a low content of cross-linker (2%) the fiber is almost 3 times stronger and 4 times stiffer than the fiber without a cross-linker. At higher content of genipin (10%), the elongation at break increases by a factor of 2 and the energy at break increases by a factor of 5. The cross-linking also enables the spinning of microfibers from long straight PNFs, which has not been achieved before. These microfibers have higher stiffness and strength but lower ductility and toughness than those made from curved PNFs. The fibers spun from the two classes of nanofibrils show clear morphological differences. The study demonstrates the production of protein-based microfibers with mechanical properties similar to natural protein-based fibers and provides insights about the role of the nanostructure in the assembly process.

Late Retrograde Aortic Dissection after Hybrid Thoracic Endovascular Aortic Repair (TEVAR): A Case Report.

Open total arch replacement is allied to high rates of mortality and morbidity; surgeons, therefore, tend to choose hybrid aortic arch repair as a less invasive operative procedure for the treatment of aortic arch aneurysms, especially in high-risk patients. However, studies on the early and late outcomes of patients undergoing hybrid aortic arch repair have revealed high rates of reintervention and reoperation compared with open total arch replacement. Here, we describe a male patient with late retrograde aortic dissection after hybrid thoracic endovascular aortic repair for aortic arch aneurysms. The patient returned 3 years after the procedure with signs of dyspnea on exertion and chest pain. Transthoracic echocardiography and computed tomography showed dissection of the ascending aorta, for which he underwent a redo Bentall procedure. The patient was weaned from cardiopulmonary bypass without any problem and discharged after 7 days.

Smoking Cessation After Surgery and Midterm Outcomes of Surgical Revascularization.

BACKGROUND: Although multiple studies have reported the devastating effect of cigarette smoking (CS) on short-term outcomes of patients who underwent coronary artery bypass grafting surgery (CABG), its effect on long-term outcomes is still questionable. We aimed to evaluate the long-term outcomes of CS cessation after CABG surgery. METHODS: This retrospective cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016 and were cigarette smokers either just before or at the time of surgery. Patients were stratified into those who continued CS and those who were persistently CS abstinent after CABG. The endpoints of the study were 5-year mortality and 5-year major adverse cardiovascular and cerebrovascular events. RESULTS: Of 28,945 patients who underwent isolated CABG, 9173 current cigarette smokers (93.5% men; mean age, 58.6 years) met our selection criteria and were included in the final analysis. Of these 3302 patients (40.0%) continued CS after surgery and 5688 patients were persistently abstinent. Multivariable survival analysis demonstrated that CS cessation after CABG, adjusted for major coronary risk factors, could reduce the 5-year mortality by 35% (hazard ratio, 0.65; 95% confidence interval, 0.54-0.77; P < .001) and 5-year major adverse cardiovascular and cerebrovascular events by 18% (hazard ratio, 0.82; 95% confidence interval, 0.74-0.92; P = .001). CONCLUSIONS: Our study shows that CS abstinence after CABG significantly reduces long-term mortality and number of major adverse events. As a result, patients who smoke should be encouraged to participate in CS cessation programs after CABG surgery.

Poly(ε-caprolactone)/triclosan loaded polylactic acid nanoparticles composite: A long-term antibacterial bionanocomposite with sustained release.

In this study, the antibacterial bionanocomposites of poly(ε-caprolactone) (PCL) with different concentrations of triclosan (TC) loaded polylactic acid (PLA) nanoparticles (30wt% triclosan) (LATC30) were fabricated via a melt mixing process in order to lower the burst release of PCL and to extend the antibacterial activity during its performance. Due to the PLA's higher glass transition temperature (Tg) and less flexibility compared with PCL; the PLA nanoparticles efficiently trapped the TC particles, reduced the burst release of TC from the bionanocomposites; and extended the antibacterial property of the samples up to two years. The melt mixing temperature was adjusted to a temperature lower than the melting point of LATC30 nanoparticles; therefore, these nanoparticles were dispersed in the PCL matrix without any chemical reaction and/or drug extraction. The sustained release behavior of TC from PCL remained unchanged since no significant changes occurred in the samples' crystallinity compared with that in the neat PCL. The elastic moduli of samples were enhanced once LATC30 is included. This is necessary since the elastic modulus is decreased with water absorption. The rheological behaviors of samples showed appropriate properties for melt electro-spinning. A stable process was established as the relaxation time of the bionanocomposites was increased. The hydrophilic properties of samples were increased with increasing LATC30. The proliferation rate of the fibroblast (L929) cells was enhanced as the content of nanoparticles was increased. A system similar to this could be implemented to prepare long-term antibacterial and drug delivery systems based on PCL and various low molecular weight drugs. The prepared bionanocomposites are considered as candidates for the soft connective tissue engineering and long-term drug delivery.

Transseptal Approach versus Left Atrial Approach to Mitral Valve: A Propensity Score Matching Study.

BACKGROUND: Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching. METHODS: This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI). RESULTS: The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274). CONCLUSION: In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.

Early outcome of off-pump versus on-pump coronary revascularization.

INTRODUCTION: The use of coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB) or without CPB technique (off-pump) can be associated with different mortality and morbidity and their outcomes remain uncertain. The goal of this study was to evaluate the early outcome of on-pump versus off-pump CABG. METHODS: We conducted a retrospective database review of 13866 patients (13560 patients undergoing on-pump CABG and 306 patients undergoing off-pump CABG) at Tehran Heart Center between January 2002 and January 2007. We compared preoperative, operative, and postoperative characteristics between them. RESULTS: In-hospital mortality in the on-pump group was 0.8% compared to 0.7% in the off-pump group (P=0.999) and in-hospital morbidity was 11.7% and 6.5%, respectively (OR: 1.533, 95%CI: 0.902-2.605, P=0.114). Postoperative atrial fibrillation was more prevalent in on-pump versus off-pump surgery (6.0% vs 3.0%, P=0.028), however there were no statistical significant differences in other postoperative complications with regard to cardiac arrest (P=0.733), prolonged ventilation (P=0.363), brain stroke (P=0.999), renal failure (P=0.525), and postoperative bleeding (P=0.999). The mean length of stay in hospital (P=0.156) and in ICU (P=0.498) was also similar between the two groups. CONCLUSION: The results from an Iranian population-based study showed similar early mortality and morbidity of off-pump CABG in comparison to on-pump surgery.

Impact of Angiotensin-converting enzyme inhibitors and Angiotensin receptor blockers on mortality of coronary artery bypass grafting.

BACKGROUND: There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as regards the postoperative mortality of coronary artery bypass grafting (CABG). This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. METHODS: Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 (46.38%) patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. RESULTS: The mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. Eighty-seven (0.86%) patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths inasmuch as there were 33 (0.70%) vs. 54 (1.0%) deaths in the ACEI/ARB positive and negative groups, respectively (OR: 0.628; p value = 0.09). Patients without ACEI/ARB were more likely to have a higher global ejection fraction. CONCLUSION: Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested.

Outcomes and long-term quality of life of patients with severe left ventricular dysfunction who underwent coronary artery bypass surgery.

PURPOSE: The aim of this study was to identify determinants of long-term results after coronary artery bypass surgery (CABG) in group of Iranian patients with systolic left ventricular (LV) dysfunction. METHODS: Reduced LV function was defined as an LV ejection fraction of <30%. Using our surgery database, we randomly selected 110 patients with EF < 30% and the same number of patients with EF ≥ 30% for whom demographic and clinical characteristics as well as in-hospital postoperative outcomes were available. Followup data were completed for 94 patients with EF < 30% (85.5%) and 101 patients with EF ≥ 30% (91.8%). Longterm results of the operation and the patients' quality of life were assessed for a mean follow-up period of 29.4 ± 11.0 months. RESULTS: In-hospital mortality and follow-up survival rates had no statistically differences in the low and normal EF groups (2.2% vs. 1.1% and 86.0% vs. 93.6%, respectively). Long-term surgical morbidity occurred in 43.6% of patients with severe LV dysfunction and in 38.6% of normal EF patients; it was considered similar for the two groups. Family history of coronary artery disease, New York Heart Association class IV, and moderate mitral insufficiency were the main predictors of long-term morbidity. Regarding the quality-of-life assessment, patients with severe LV dysfunction attained significantly lower levels of social activities. CONCLUSION: Patients with severe LV dysfunction in comparison with those with normal LV function had similar 3-year survival rates and long-term complications. To improve survival following CABG in patients with severe LV dysfunction, mitral valve repair/replacement at the time of the initial operation should be considered.

Knowledge management in cardiac surgery: the second tehran heart center adult cardiac surgery database report.

BACKGROUND: The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. METHODS: All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. RESULTS: There were 24959 procedures performed: 19663 (78.8%) isolated coronary artery bypass grafting surgeries (CABGs); 1492 (6.0%) isolated valve surgeries; 1437 (5.8%) CABGs concomitant with other procedures; 832 (3.3%) CABGs combined with valve surgeries; 722 (2.9%) valve surgeries concomitant with other procedures; 545 (2.2%) surgeries other than CABG or valve surgery; and 267 (1.1%) CABGs concomitant with valve and other types of surgery. The overall mortality was 205 (1.04%), with the lowest mortality rate (0.47%) in the isolated CABGs and the highest (4.49%) in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males (1.90% vs. 0.74%, respectively). CONCLUSION: Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD.

Determinants of social activity and work status after coronary bypass surgery.

Despite the occurrence of adverse events after coronary artery bypass, the degree of social integration can be increased following this operation. This study addresses the predictive power of risk factors as well as clinical status in determining long-term social functioning and rate of return to work following isolated bypass surgery. A prospective cohort study was conducted in 178 patients who underwent isolated bypass surgery between 2004 and 2007. Information on work status and social relationships was obtained 1-2 days before surgery and during a mean follow-up of 29.4 ± 1.1 months. The proportion of patients who engaged in social activities at 2, 3, and 4 years of follow-up was 0.3, 0.6, and just over 0.8, respectively, and the proportion who had returned to work at these time points was 0.2, 0.45, and 0.63, respectively. Social activity after surgery was less in patients with left ventricular dysfunction, cerebrovascular disease, and higher New York Heart Association functional class. The rate of return to work was lower for men and for patients with left ventricular dysfunction, diabetes, cerebrovascular disease, and those who were hospitalized for more than 14 days.

Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery.

INTRODUCTION AND OBJECTIVES: Atrial arrhythmias occur after cardiac surgery in 10-65% of patients. The most common postoperative arrhythmia is atrial fibrillation (AF). METHODS: The Tehran Heart Center Cardiovascular Research database (of 15 580 patients) was used to identify all patients who developed any form of AF as a postoperative complication following their first cardiac surgery (e.g. for coronary artery bypass grafting [CABG], valve surgery or both), with and without cardiopulmonary bypass, between June 2002 and March 2008. RESULTS: Of the 15 580 patients who underwent a first cardiac surgery, 11 435 (73.4%) were male and their mean age was 58.16+/-10.11 years. New-onset AF developed postoperatively in 1129 (7.2%). New-onset AF occurred most frequently in patients who were aged > or =60 years and who had no history of beta-blocker use. In addition, patients were more likely to develop new-onset AF if they had valve surgery alone (16.5%) or CABG plus valve surgery combined (9.6%), needed intra-aortic balloon counterpulsation (IABC), or had a long cardiopulmonary bypass time. Multivariate analysis identified the following predictors of postoperative AF: older age, history of renal failure, congestive heart disease, operation type, longer perfusion time, and use of IABC. The incidence of early readmission (4.4%) was significantly higher in patients with postoperative AF, as was the duration of hospitalization, both overall and postoperatively. The short-term postoperative mortality rate was 3.8%. CONCLUSIONS: Atrial fibrillation frequently develops after cardiac surgery and is associated not only with increased morbidity and mortality, but also with increased use of health-care resources.

Factores determinantes de fibrilación auricular postoperatoria y el uso de recursos en cirugía cardiaca / Determinants of postoperative atrial fibrillation and associated resource utilization in cardiac surgery

Introducción y objetivos. Las arritmias auriculares tras cirugía cardiaca se dan en un 10-65% de los pacientes. La fibrilación auricular (FA) es la arritmia más frecuente tras la cirugía cardiaca. Métodos. Se utilizó la base de datos para investigación cardiovascular del Tehran Heart Center (15.580 pacientes) para identificar a todos los pacientes que presentaron algún tipo de FA como complicación postoperatoria tras su primera intervención de cirugía cardiaca (bypass arterial coronario, cirugía valvular o bypass más cirugía valvular) con o sin bypass cardiopulmonar (BCP), entre junio de 2002 y marzo de 2008. Resultados. De los 15.580 pacientes a los que se practicó una primera operación de cirugía cardiaca, 11.435 (73,4%) eran varones con una media de edad de 58,16 ± 10,11 años. Se produjo una FA postoperatoria de nueva aparición en 1.129 (7,2%) de estos pacientes. La FA de nueva aparición fue más frecuente en los pacientes de edad ≥ 60 años que no tenían antecedentes de tratamiento con bloqueadores beta. Los pacientes con una FA de nueva aparición tenían también mayor probabilidad de que se les hubiera practicado una operación de cirugía valvular (16,5%) o de bypass más cirugía valvular (9,6%), así como de necesidad de balón de contrapulsación intraaórtico (BCIA) y un tiempo de bypass cardiopulmonar mayor. Los factores predictivos de la aparición de FA postoperatoria en el análisis multivariable fueron la mayor edad, los antecedentes de insuficiencia renal, la insuficiencia cardiaca congestiva, el tipo de operación, el mayor tiempo de perfusión y el uso de BCIA. En los pacientes con FA postoperatoria hubo una incidencia significativamente superior de reingresos tempranos (4,4%), así como una duración de la hospitalización (DdH) y una DdH postoperatoria más prolongadas. La tasa de mortalidad postoperatoria temprana fue del 3,8%. Conclusiones. La aparición de FA es frecuente tras la cirugía cardiaca y se asocia no sólo a un aumento de la morbimortalidad, sino también a un incremento de la utilización de recursos (AU)

Introduction and objectives. Atrial arrhythmias occur after cardiac surgery in 10-65% of patients. The most common postoperative arrhythmia is atrial fibrillation (AF). Methods. The Tehran Heart Center Cardiovascular Research database (of 15 580 patients) was used to identify all patients who developed any form of AF as a postoperative complication following their first cardiac surgery (e.g. for coronary artery bypass grafting [CABG], valve surgery or both), with and without cardiopulmonary bypass, between June 2002 and March 2008. Results. Of the 15 580 patients who underwent a first cardiac surgery, 11 435 (73.4%) were male and their mean age was 58.16±10.11 years. New-onset AF developed postoperatively in 1129 (7.2%). New-onset AF occurred most frequently in patients who were aged ≥60 years and who had no history of beta-blocker use. In addition, patients were more likely to develop new-onset AF if they had valve surgery alone (16.5%) or CABG plus valve surgery combined (9.6%), needed intra-aortic balloon counterpulsation (IABC), or had a long cardiopulmonary bypass time. Multivariate analysis identified the following predictors of postoperative AF: older age, history of renal failure, congestive heart disease, operation type, longer perfusion time, and use of IABC. The incidence of early readmission (4.4%) was significantly higher in patients with postoperative AF, as was the duration of hospitalization, both overall and postoperatively. The short-term postoperative mortality rate was 3.8%. Conclusions. Atrial fibrillation frequently develops after cardiac surgery and is associated not only with increased morbidity and mortality, but also with increased use of health-care resources (AU)

Determinant factors of renal failure after coronary artery bypass grafting with on-pump technique.

OBJECTIVE: The aim of the present study was to investigate the determinant factors of acute renal failure (ARF) after isolated on-pump coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: This was a retrospective study of 13,315 adult patients who underwent isolated CABG with cardiopulmonary bypass (CPB) in Tehran Heart Center from May 2002 to May 2007. The exclusion criteria were age <18, concomitant cardiac and/or noncardiac surgical operations, history of renal failure before surgery, and chronic renal failure requiring dialysis. Preoperative and operative variables were measured, and a multivariate logistic regression model was constructed to identify the independent risk factors for developing renal failure after on-pump CABG. RESULTS: Of the 13,315 patients, 3,347 (25.4%) and 90,883 (74.6%) were females and males, respectively, with a mean age of 58.63 +/- 9.48 years. ARF was detected in 85 (0.6%) of the patients with isolated on-pump CABG. The mean age of the patients was 58.63 +/- 9.48 years, and 25.5% of them were female. The multivariate logistic regression analysis identified age (OR = 1.035; p = 0.002), female gender (OR = 1.622; p = 0.037), history of peripheral vascular disease (PVD) (OR = 2.579; p = 0.042), diabetes mellitus (OR = 1.918; p < 0.001), emergent and urgent surgery (OR = 1.744 and OR = 7.901, respectively; p = 0.003), CPB time >70 min (OR = 1.944; p = 0.007), and intra-aortic balloon pump (IABP) insertion (OR = 10.181; p < 0.001) as the independent risk factors for ARF. CONCLUSION: The data showed that age, female gender, positive history of diabetes and PVD, urgent and emergent surgery, CPB time >70 min, and need for IABP were the independent determinant factors of ARF after on-pump CABG.

Short- and mid-term results of triple-valve surgery with an evaluation of postoperative quality of life.

The decision to proceed with triple-valve surgery should take into account reasonable estimates of the risk of the surgery and of the potential benefit to be gained. In the present study, we reviewed our experience with triple-valve surgery, focusing on short-term death and morbidity, mid-term survival, and postoperative quality of life.Among 107 patients with multiple-valve disease who underwent triple-valve surgery at Tehran University Heart Center from January 2002 through December 2007, 100 patients with complete, recorded data were entered into the study. Demographic and clinical characteristics and in-hospital postoperative complications were considered. Among 66 patients whose mid-term operative outcomes we were able to determine, these results were evaluated, together with their quality of life, during a mean follow-up period of 45.0 +/- 12.4 months.In-hospital mortality and morbidity rates were 5% and 61%, respectively. The Kaplan-Meier survival rate for the 66 monitored patients was 82.6%. Freedom from readmission was 77.3%, and freedom from rehospitalization was 89.4%. Freedom from thromboembolism was 87.8%, and freedom from anticoagulant-related hemorrhage was 91.3%. In the quality-of-life assessment, suitable physical and social activities were reported in 65.1% and 60.6% of patients, respectively. Although 63.6% of patients were satisfied with the results of the operation, only 51.5% were able to continue their work.Despite patients' satisfaction with early outcomes of triple-valve surgery and their acceptable mid-term survival rates, the improvement of quality of life after surgery is still far from ideal.

Factors predicting discontinuation of a hospital-based cardiac rehabilitation programme.

BACKGROUND: Cardiac rehabilitation (CR) programmes play an important role in the management of patients with coronary artery disease. However, a significant proportion of patients do not participate or do not complete CR. AIM: To asses the prevalence and predictors of discontinuation of a hospital-based CR programme and to investigate whether or not the completers and dropouts differed in relation to their baseline characteristics. METHODS: Data used for analysis were from a hospital-based CR programme involving 1986 discharged patients at Tehran Heart Centre between July 2004 and January 2006. The patients who completed all 24 sessions of the CR programme were compared with the dropouts. RESULTS: The CR completion rate was 18.1% (average of 11.4+/-8.1, ranging from 1 to 78 sessions) including patients who completed 24 (n=284) or more sessions (n=77) of the CR programme. Factors predicting dropout were male gender (OR 1.441, p=0.0094), younger age (OR 0.979, p=0.005), and lower levels of education (OR 0.412, p <0.0001). CONCLUSION: The present study demonstrated a relatively high rate of CR programme dropout. Only less than a fifth of the patients completed this hospital-based programme. Patients who were male and younger and had lower education levels were better likely to drop out of the CR programme. Social support and educational programmes may be helpful in achieving better compliance.

Relationship between body mass index and left main disease: the obesity paradox.

BACKGROUND AND AIMS: Obesity is a well-known risk factor for development of diabetes, hypertension, and coronary artery disease. However, the obesity paradox shows that short-term outcome has been reported to be superior after revascularization in overweight patients. We conducted this study to examine this theory in patients who were candidates for coronary artery bypass graft and to determine if there is a relationship between obesity and the severity of coronary artery involvement and left main disease in Iranian patients. METHODS: A total of 15,550 patients who had undergone isolated coronary artery bypass graft were studied retrospectively. All medical records of the aforementioned patients were derived from our hospital surgery data bank. Preoperative angiography was used for angiographic data. RESULTS: After adjusting for confounding variables, we still found a significant relationship with higher BMI and lower prevalence of left main disease. CONCLUSIONS: We found that despite a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia, overweight and obese patients who were candidates for coronary artery bypass graft surgery were significantly less likely to have left main disease according to preoperative angiography. This study suggests that obese patients are more likely to be referred for coronary artery bypass graft in earlier stages of coronary involvement.