The Egyptian Cardiothoracic Surgeon

Comparing the Efficacy of Custodiol and Cold Blood Cardioplegia in Myocardial Preservation

2024-03-03T11:10:09+02:00

Background: Strategies for myocardial protection vary among surgeons, and data on the optimal cardioplegia solution are insufficient. The perfect cardioplegia solution for myocardial protection during cardiac surgery is still controversial. This study aimed to compare the efficacy of custodiol and cold blood cardioplegia in preserving the myocardium.

Methods: In this comparative prospective study, the patients were split into two groups of 60 patients each. Group A received Custodiol HTK solution, whereas Group B received cold blood cardioplegia. Preoperative laboratory investigations, operative data, postoperative ICU stays, and complications were compared between groups.

Results: The number of cardioplegia doses was significantly greater in Group B (1.05 ± 0.22, vs. 1.90 ± 0.82; p<0.001). There were no significant differences between the cardioplegia groups regarding hospital stay (p= 0.246), intensive care unit stay (p= 0.144), mortality (p= 0.769), low cardiac output (p>0.99), postoperative myocardial infarction (p= 0.432), intra-aortic balloon pump insertion (p= 0.224), reoperation (p>0.99), duration of mechanical ventilation (p= 0.389), pulmonary complications (p= 0.432), stroke (p>0.99), or the need for renal dialysis (p= 0.559).

Conclusions: Custodiol cardioplegia could be advantageous in cardiac surgeries when a longer duration is expected. However, this study did not report differences in postoperative outcomes between patients with custodiol or cold blood cardioplegia.

Prognostic Impact of Previous Percutaneous Coronary Intervention on the Outcome of Coronary Artery Bypass Grafting in Multivessel Disease Diabetic Patients

2024-03-03T11:10:09+02:00

Background: Previous studies suggest that patients who receive percutaneous coronary intervention (PCI) are at a higher risk of undergoing coronary artery bypass grafting (CABG). This study aimed to investigate the risk of CABG in patients with a history of PCI.

Methods: One hundred diabetic patients who underwent CABG from October 2020 to February 2022 were enrolled and divided into two groups. Group I consisted of 50 patients with no prior PCI, while Group II comprised 50 patients with a history of PCI.

Results: The mean age was 57.4 ± 8.67 years for Group I and 59.72 ± 7.5 years for Group II (p= 0.155). The mean cardiopulmonary bypass time was 108.56 ± 34.53 minutes for Group I and 127.4 ± 35.93 minutes for Group II (p=0.009). The ischemic duration was 75.68 ± 19.94 minutes for Group I and 75.12± 23.02 minutes for Group II. The mean number of grafts was greater in Group I (3.5 (3 – 3.5) vs. 3 (2 – 4), p= 0.011). The mean ventilation time was 9 (5 – 13.75) hours for Group I and 10 (5 – 19) hours for Group II. The mean length of ICU stay was 1 (1–2) day for Group I and 2 (2–3) days for Group II (p<0.001). The length of hospital stay was 8 (7–9) days for Group I and 10 (9–11) days for Group II (p<0.001). There were statistically significant differences between the groups in terms of MACE (higher in the PCI group, p=0.046), improvement in wall motion abnormalities (higher in the non-PCI group, p=0.007), and postoperative normal ejection fraction (higher in the non-PCI group, p=0.032). There was no significant difference in hospital mortality between the two groups (0 vs 3), with a p value =0.07.

Conclusion: A previous PCI could increase post-CABG morbidity and MACEs. However, no significant difference in postoperative mortality rates was found between patients who underwent prior PCI and those who did not.

Penetrating chest trauma: A prospective study of prognostic factors for worse outcome after emergency surgery

2024-03-03T11:10:09+02:00

Background: Even though chest penetrating injuries are common as well as challenging to treat, most of the time they can be dealt without surgery. This study aimed to evaluate contemporary outcome following emergent surgical interventions for penetrating chest trauma and possible factors associated with poor prognosis.

Methods: This prospective study included 100 cases admitted to benha university hospital with either Stab Wound or Gunshot wound to the chest, with systolic blood pressure ≤90 mmHg and who underwent through Thoracotomy or sternotomy within duration of one hour of arrival.

Results: This study included 81 patients (77 stabbings, 4 gunshots) underwent a thoracotomy and 19 underwent median sternotomy within 60 minutes after the penetrating trauma, the mean period of surgery was 3 ±0.9, There were 94 male and 6 female cases and their mean age was 25 ±10.14 years, the mean Intensive care unit stay was 2 ±0.83 days in addition mean hospital stay was 6 ±1.06 days, the individuals who died had trauma at mid-clavicular line of the chest (100%) compared to survivors (5.5%), lesser systolic blood pressure on presentation in the emergency room (71 ±11 mmHg) equated with those who survived (90 ±9 mmHg, P<0.001) and lower hemoglobin level (6.4 ±0.5) compared with those who survived (8.4 ±1, P<0.001). As a whole, the mortality rate was 9% (n=9). individuals' Death Rates with stab wounds was 5/96 (5.2%) compared with 4/4 (100%) for patients with gunshot wounds. Right ventricular injury (P=0.03) was associated with mortality.

Conclusion: Early referral, within one hour, to emergency surgery results in acceptable postoperative mortality in patients with penetrating chest trauma. Anterior location of injury, initial hemodynamic instability, and gunshot wounds associated with poor prognosis.