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BACKGROUND: Hypofibrinogenemia is an independent factor of excessive bleeding after congenital cardiac surgeries. Fresh frozen plasma (FFP) and fibrinogen concentrate are examples of recommended products for management of hypofibrinogenemic bleedings. Unfortunately, there is no study to compare these treatments in pediatric cardiac surgeries. Therefore, this study aimed to compare the effect of fibrinogen concentrate with FFP on postoperative bleeding and clinical outcome after congenital cardiac surgeries in pediatric population. METHODS: Phis prospective clinical trial study was carried out on 90 consecutive pediatric patients who underwent congenital cardiac surgeries. The eligible pediatrics who met our study criteria, randomly received FFP (10 ml/kg) or fibrinogen concentrate (70 mg/kg) to assess postoperative bleeding and blood-products requirements. RESULTS: Each of FFP and fibrinogen concentrate significantly reduced total chest tube drainage (CTD) at 3, 6, 12, and 24 postoperative hours (P = 0.04). The analysis of time*intervention revealed that our intervention (fibrinogen group) significantly reduced CTD more (P = 0.01). Moreover, fibrinogen group had a significantly higher plasma fibrinogen level in first 24 hours (P = 0.02). CONCLUSION: Nowadays, both of fibrinogen concentrate and FFP product are widely used for management of hypofibrinogenic bleedings after cardiac surgeries. According to our results, we concluded that although the both product had a comparable effect on management of hypofibrinogenemic bleeding in pediatrics undergoing congenital cardiac surgeries, choosing better product depended on general condition of patients such as their body fluid status.
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INTRODUCTION: Pulmonary insufficiency (PI) frequently develops in patients who underwent repair of tetralogy of fallot (TOF). The aim of present study was to assess the effect of pulmonary valve replacement (PVR) on hemodynamics of patients who underwent repair of TOF. METHODS: This retrospective cohort carried out between July 2010 and October 2012 among consecutive PVRs of 19 patients who underwent TOF surgery. The PVRs was performed using bioprosthetic (n=17) and mechanical (n=2) valves. Our data was collected during follow up visits within 6 to 12 month after PVR. RESULTS: Our results show that PVR significantly decreased right ventricular end-diastolic volume (180.89±13.78 vs. 107.21±12.02 ml/m(2), P < .01), right ventricular end-systolic volume (105.42±15.98 vs. 58.15±11.67 ml/m(2), P < .01), RV mass (47.78±6.20 vs. 30.68±8.95 g/m(2), P < .01), and PI (48.21±1.43% vs. 12.68±5.60%, P < .01). Moreover, left ventricular end-diastolic volume significantly increased (78.05±17.21 vs. 90.78±14.82 ml/m(2), P < .01) after PVR. The other hemodynamics indexes did not change, significantly. CONCLUSION: Despite the controversies about efficacy of PVR after repair of TOF, the remarkable improvement of hemodynamic is a supportive rationale for performing PVR surgery in TOF patients.
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BACKGROUND: Coronary artery bypass graft is one of common cardiac surgeries which unfortunately accompany with some adverse events such as delirium. Proinflammatory processes play an important role in pathogenesis of post-operative delirium. Therefore, the effect of dexamethasone (DEX) on post-operative delirium after cardiac surgery was evaluated. MATERIALS AND METHODS: This randomized clinical trial study was conducted with objective of evaluation of DEX effects on post-operative deliriums and complications after cardiac surgery. Ninety three eligible patients who undergone coronary arteries bypass graft was divided into two groups of DEX with 43 patients and placebo (PCB) with 50 patients. DEX group taken 8 mg DEX intra-venous before induction of anesthesia followed by 8 mg every 8 h for 3 day and other group received PCB in same way. RESULTS: All patients assessed by Mini-mental status questionnaire and psychiatric interviewing with aim of diagnosing delirium. Extubation time of DEX group was significantly reduced. The first post-operative day deliriums, extubation time, hospital, and intensive-care unit length of stay significantly reduced in DEX group without increasing serious complications such as infectious disease. After administration of DEX only hyperglycemia as an adverse event was increased in DEX group. Other complications of renal, cardiac, cerebrovascular and respiratory system did not show any significant differences between groups. CONCLUSION: Pre-operative administration of DEX might safely protect brain of the patients who undergone cardiac surgery against post-operative delirium.
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BACKGROUND: Postoperative delirium (POD) is one of the important complications of cardiac surgery and it is assumed to provoke inflammatory responses. Theoretically, anti-inflammatory effects of dexamethasone can have an influence on the incidence and outcomes of POD. The aim of our study was to assess POD predictors and outcomes of dexamethasone administration after cardiac surgery. METHODS: Patients' mental status was examined by mini-mental status examination and psychiatric interviewing to diagnose delirium. Subsequently, authors analyzed the patient variables for identification of predictors and outcomes of POD. RESULTS: Between 196 patients who met the inclusion criteria, 34 (17.34%) patients were delirious. History of chronic renal failure, obstructive pulmonary disease, smoking, and addiction strongly predicted development of POD. Other predictors were intra-aortic balloon pump insertion, transfusion of packed cells, and atrial fibrillation rhythm. In our study, the administration of dexamethasone significantly reduced the risk for POD. Furthermore, delirium was associated with longer intensive care unit (ICU) stay. CONCLUSION: Our study reports the predictors of POD, which patients commonly facing them in cardiac surgery ICU. Appropriate management and prevention of these predictors, especially modifiable ones, can decrease the incident of POD and improves cognitive outcomes of cardiac surgeries.
