Custodial-HTK Solution for Myocardial Protection in CABG Patients.

BACKGROUND: Many steps of myocardial preservation during open heart surgery are practical after the development of the heart-lung machine. A cardioplegia solution, infused after aortic cross clamping, is an important aspect. Two-thirds of cardioplegia solutions are an intracellular solution (such as HTK or Bretschneider solution) or extracellular solution (such as blood cardioplegia). Intracellular cardioplegia solution can provide protection for 3-4 hours after one-time infusion, which differs from extracellular cardioplegia solution requiring intermittent use every 20-30 minutes. MATERIAL AND METHOD: Retrospective case-control study in CABG patients were reviewed in Cardiovascular and Thoracic Unit, Department of Surgery, Khon Kaen University during April 2011 and September 2012. The study group was divided into groups A and B, for myocardial protection by blood cardioplegia and Custodiol-HTK (Histidine-Tryptophan-Ketoglutarate) solutions. Baseline data such as age, sex, NYHA, risk factors, associated disease, operation, CPB time, aortic cross clamp time, complication, defibrillation after surgery, ICU stay, length of stay and mortality rate were analyzed. RESULTS: The study patients in groups A and B were 60 and 65 cases. Defibrillation after finishing CABG in groups A, B was 8.3% and 33.8%. Mortality rate in groups A, B were 1.7% and 4.6%. Other post operative complications were similar in both groups. CONCLUSION: There was significantly more spontaneous ventricular fibrillation after release of cross clamping in HTK group. Clinical outcome of single doses of antegrade, cold Custodiol-HTK cardioplegia solution in CABG surgery protected the myocardium equally well as repetitive antegrade, cold blood cardioplegia.

Surgical outcomes for congenital lung malformations: 10 years experience at a single center.

OBJECTIVE: To study the surgical outcome of congenital lung malformation and natural history of the disease at Srinagarind Hospital. MATERIAL AND METHOD: Retrospectively review the medical records of 25 patients diagnosed with congenital lung malformation who underwent surgical treatment between January 2001 and December 2011. RESULTS: Twenty-five patients diagnosed with congenital lung malformation underwent surgery: 16 males (64%), 9 females (36%), median age seven months, median body weight 6 kg. Twelve (48%) had congenital cystic adenomatoid malformation congenital cystic adenomatoidmaflormation (CCAM), seven (28%) pulmonary sequestration, four (16%) congenital lobar emphysema, and one a bronchogenic cyst (4%). The most common presenting symptoms were respiratory tract infection (14, 56%), respiratory distress (7, 28%), lung abscess (1, 4%), hemoptysis (1, 40%), and asymptomatic (2, 8%). Post-operative mortality over 30 days was 0. Complications included lung infection, atelectasis, post-operative bleeding, and wound infection. Post-operative follow-up (lasting between 1-8 years) revealed normal tolerance to daily activity without any respiratory problems. CONCLUSION: Surgical treatment for congenital lung malformations had a good result with few complications.

The posterior pericardiotomy. Does it reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting?

Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass graft surgery (CABG). Posterior pericardiotomy (PP) has been reported toreduce pericardial effusion, AF triggel; and reduce the length of hospital stay and hospital costs without significant complications. A total of 20 patients, diagnosed with coronary artery diseases to be treated by an elective or urgent CABG between August and December 2013, were randomly divided into two groups; 10 patients received PP (PP group) and 10 patients did not receive PP (control group). The incidence ofAF was equal (40% in both groups). Early pericardial effusion was slightly higher in the PP group (PP 70%, control 60%; p = 1.00). The incidence of left pleural effusion and pneumonia were higher in the PP group than in the control. Moreover, one patient in the PP group developed perioperative myocardial infarction (MI) that required intensive care with medication. The duration of ICU stay of the PP group was significantly longer than that of the control group. In conclusion, PP did not reduce the incidence of postoperative AF nor did early pericardial effusion. Rather, PP increased post-operative complications such asperioperative MI, left pleural effusion, and pneumonia resulting in the prolonged ICU stay.

Role of silicone derivative plus onion extract gel in presternal hypertrophic scar protection: a prospective randomized, double blinded, controlled trial.

Use of silicone derivative and onion extract had been reported in the prevention of hypertrophic scarring. Our experience showed the preventive use of silicone derivative plus onion extract gel on hypertrophic scars after median sternotomy. In a randomized, double blinded, placebo-controlled study, 60 patients after median sternotomy incisions were separated into two groups. All patients were treated either with silicone derivative plus onion extract gel (Cybele(®) scagel) or placebo gel twice daily for a total treatment period of 12 weeks. During each visit, pain and itching scores were graded by the patients and scar characteristics were observed by surgeons using the Vancouver scar scale. Pain and itch score values from patients' who applied silicone derivative plus onion extract gel was less than another group (P < 0·05). Pigmentation was significantly different between two groups (P < 0·05) and the reduction of scores on vascularity, pliability, height in treated group was not superior to the untreated group. No adverse events were reported by any of the patients. A silicone derivative plus onion extract gel is safe and effective for the preventing the hypertrophic scarring after median sternotomy.