The Egyptian Cardiothoracic Surgeon

Incidence, Predictors, and Prognostic Impact of New-onset Atrial Fibrillation After Isolated Primary Coronary Artery Bypass Grafting

Khalid Osman, Hussein Nofal — Wed, 01 Jan 2025 00:00:00 +0200

Background: New-onset atrial fibrillation (NOAF) after coronary artery bypass grafting (CABG) is associated with considerable morbidity and mortality. The objectives of this study were to estimate the incidence and predictors of NOAF after isolated primary CABG and evaluate its prognostic impact on the hospital outcomes of surgery.

Methods: This study included 154 consecutive patients who underwent isolated primary CABG between October 2021 and February 2022. Patients were divided into two groups; Group 1 included patients with NOAF, and Group 2 had patients without NOAF.

Results: NOAF occurred in 29 patients (18.8%). NOAF patients were significantly older (52.13± 6.30 vs. 55.45± 7.47 years; p =0.028), with more prevalence of diabetes mellitus but did not reach a significant level (62.1% vs. 44.8%; p = 0.094) and had a greater preoperative white blood cells count (WBCs) (8.87± 2.95 vs. 8.0± 2.17 /mm3; p = 0.071). Preoperative creatinine clearance (137.58± 53.94 vs. 114.94± 39.18 ml/min; p = 0.04), postoperative ischemic ECG changes (55.2% vs. 30%; p = 0.004), perioperative myocardial infarction (31% vs. 15.2%; p= 0.046), postoperative CK-MB (84.83± 81.26 vs. 64.76±46.58 units; p= 0.077), hemodynamic instability (72.4% vs. 41.6%; p= 0.003), and postoperative significant ECG changes (34.5% vs. 17.6%; p= 0.044) were greater in patients with NOAF. Age, preoperative creatinine clearance, preoperative WBC, and DM were associated with NOAF in the univariable analysis. None were found to be predictors of NOAF in the multivariable analysis.

Conclusions: NOAF after isolated primary CABG is common. Advanced age, renal function, hemodynamic instability, and perioperative myocardial infarction might be associated with NOAF

Doppler Flowmeter Is a Valuable Tool for Prevention of Early Postoperative Myocardial Infarction

Ahmed M Abdelazim, Mahmoud M Abdel Azeem Mubarak — Wed, 01 Jan 2025 00:00:00 +0200

Background: Early postoperative myocardial infarction (MI) remains a critical complication following coronary artery bypass grafting (CABG). The intraoperative use of Doppler flowmetry could improve outcomes by ensuring optimal graft patency and flow. This study evaluated the effect of Doppler flowmetry on early postoperative MI in patients undergoing CABG.

Methods: This double-blinded, randomized controlled study included 120 patients who underwent elective CABG. Patients were divided into two equal groups: Group A underwent CABG with Doppler flowmetry, and Group B underwent CABG without Doppler flowmetry. The patients' ages ranged between 45 and 60 years old, with no difference in gender distribution between groups. The primary outcomes were early postoperative arrhythmias and echocardiographic parameters. Secondary outcomes included mechanical ventilation duration, ICU stay, and complication rates.

Results: There was no difference in postoperative arrhythmias between groups (P= 0.142). Postoperative regional wall motion abnormalities occurred in 90% of Group B versus 5% of Group A (P < 0.001). Difficult weaning (10 (16.7%) vs. 25 (41.7%); P= 0.003), longer ventilation time (8 ±3 vs. 17 ±7 h; P<0.001), and prolonged ICU stay (3 (3 – 10) vs. 5 (2 – 9) days; P<0.001) were all significantly higher in Group B than that of group A. Infection and re-exploration rates were significantly higher in Group B (13.3% and 25%) than in Group A (1.7% and 6.7%) (P = 0.032 and P = 0.006, respectively). The cross-clamp time and total circulatory time were shorter in Group A (55 ± 6 minutes and 87 ± 12 minutes) than in Group B (89 ± 12 minutes and 110 ± 17 minutes) (P < 0.001). Multivariable logistic regression indicated that using Doppler flowmetry reduced the risk of reexploration by 81% (OR: 0.189, 95% CI:0.054 – 0.663, P= 0.009). There was no early mortality in both groups

Conclusion: Using Doppler flowmetry during CABG could improve intraoperative and postoperative outcomes, reducing perioperative myocardial infarction and related complications. This technique could be valuable to standard CABG procedures, enhancing patient recovery and reducing hospital stay duration.

Early Outcomes of Thoracoscopic versus Open Extended Thymectomy in Myasthenia Gravis Patients

Michael Moawad, Mohamed Elgariah, Mohamed Abo Elnasr, Elatafy Elmetwally — Wed, 01 Jan 2025 00:00:00 +0200

Background: The debate concerning the impact of surgical approaches for thymectomy on the outcomes of myasthenia gravis continues. This study aimed to present the preliminary outcomes of thoracoscopic versus transsternal thymectomy for patients with myasthenia gravis.

Methods: A total of 60 patients participated in this cohort study. Twenty-seven of these patients underwent thymectomy via video-assisted thoracoscopic surgery (VATS) with one (n= 7) or two ports (n= 20) (Group I). Thirty-three patients underwent thymectomy via the transsternal approach (Group II). The study was conducted over one year, and the patients were followed for three months postoperatively.

Results: The duration of the operation (88±9 vs. 131±6 min, P<0.001) and volume of blood loss (109±12 vs. 434± 54 ml; P<0.001) were significantly lower in the VATS patients. Additionally, early extubation was significantly more common in Group I than in Group II (100% vs. 48%; P <0.001). Compared with Group II patients, Group I patients had a significantly lower need for blood transfusions (0 vs. 6 (18%); P<0.001) and postoperative intensive care units (0 vs. 28 (85%); P <0.001). Compared with Group II, Group I had a lower VAS pain score after 24 h (4 (3-5) vs. 6 (6-7); P<0.001). Patient mobilization occurred significantly earlier in Group I than in Group II (5.89 ± 1.45 vs. 19.09 ± 6.38; P <0.001). No cases of video-assisted thoracoscopic surgery were converted to open surgery, and no cases of operative mortality were reported in either group.

Conclusions: Compared with open thymectomy, thoracoscopic thymectomy might yield superior results. Thoracoscopic thymectomy is associated with a shorter duration of operation, less blood loss, less need for blood transfusion, less need for the ICU, a lower pain score, and an earlier timing of patient mobilization. Therefore, thoracoscopic thymectomy could be preferable to open thymectomy for the surgical treatment of myasthenia gravis.