The Egyptian Cardiothoracic Surgeon

Early Outcomes of Re-Exploration for Bleeding After Elective Cardiac Surgeries in Adult Patients

Sun, 01 Mar 2026 00:00:00 +0200

Background: Re-exploration for bleeding is a serious complication following elective cardiac surgery, consistently associated with increased morbidity, mortality, prolonged hospital stay, and greater use of healthcare resources. We aimed to investigate the causes of re-exploration for bleeding in adult cardiac surgery patients, determine its impact on the outcomes, and analyze the predictors of mortality.

Methods: A prospective observational study was conducted on 200 consecutive adult patients who underwent exploration for bleeding during 1450 elective cardiac surgeries between July 2024 and March 2025.

Results: The mean age was 49.18 ± 12.71 years, and 26.5% were females. Comorbidities included diabetes (22%), hypertension (42.5%), and smoking (58.5%). Mean preoperative EF was 58.18 ± 6.54%. Procedures included CABG (43%), mitral valve replacement (22%), double valve replacement (17.5%), aortic valve replacement (15%), and Bentall (2.5%). Mean cardiopulmonary bypass and cross-clamp times were 120.01 ± 35.32 and 88.31 ± 23.90 minutes, respectively. Early mortality was 7.5%. Major complications included shock (4.5%), massive transfusion (18%), and renal failure (2%). Most re-explorations occurred within 6–12 hours (47%). Bleeding was surgical in 81.5% and medical in 18.5%. Multivariable regression identified prolonged mechanical ventilation as a significant predictor of early mortality (OR = 1.226, p = 0.016).

Conclusion: Surgical causes predominate in postoperative bleeding, though medical causes remain significant. Bleeding is associated with significant morbidity and mortality. Preventive surgical measures and multidisciplinary management are essential to improve outcomes

Effect of Elevated Glycated Hemoglobin on Sternal Wound Infection in Diabetic and Non-Diabetic Patients of Urgent Coronary Artery Bypass Grafting

Ahmed Emara, Hany Elrakhawy, Moataz Rezk, Ahmed Elmorsy — Sun, 01 Mar 2026 00:00:00 +0200

Background: Incidence of cardiovascular diseases is high, and it occurs earlier in diabetic patient. This study aimed to examine the impact of elevated glycated hemoglobin (HbA1c) on the development of sternal wound infection in diabetic and non-diabetic patients who undergo isolated urgent coronary surgery.

Methods: This prospective study included all patients undergoing urgent coronary surgery through standard median sternotomy at Department of Cardiothoracic Surgery in Benha University Hospital. Patients were divided into 2 groups: Group 1 (n=40): diabetic cases and Group 2 (n=35): non-diabetic cases.

Results: The univariate logistic regression analysis showed that only HbA1c was a significant predictor for AF. While HbA1c, FBG and EF were the only significant predictors for sternal wound infection. Also, only HbA1c and FBG were significant predictors for 30-day mortality.

Conclusion: Patients with a higher HbA1c percentage experienced a higher incidence of deep sternal incision infection and mortality subsequent to coronary artery bypass grafting, as indicated by the findings. This suggests that diabetic patients need for stringent glycemic control prior to any surgical interventions.

Preoperative Left Atrial Parameters as Predictive Factors for Post-Coronary Artery Bypass Grafting Atrial Fibrillation

Ashraf Mostafa, Amr Bastawisy , Mahmoud El Nagar, Ihab Elsharkawy — Sun, 01 Mar 2026 00:00:00 +0200

Background: Atrial fibrillation (AF) is the most common arrhythmia following coronary artery bypass grafting (CABG), affecting 10% to 40% of patients. Multiple patient-specific and anatomical factors are associated with AF, among which left atrial (LA) size is a key predictor. This study aimed to derive a simple clinical index to identify patients at high risk for AF using available preoperative predictors, including the left atrial volume index (LAVI).

Methods: This prospective observational cohort study enrolled 140 adult patients of both sexes with preoperative sinus rhythm undergoing isolated CABG. Patients were categorized into two groups: an AF group (n=9) and a non-AF group (n=131).

Results: Patients who developed postoperative AF had a significantly higher risk of mortality (p = 0.049), cardiovascular complications (p = 0.034), and congestive heart failure (p = 0.043). However, no significant differences were observed in surgical site infection (p = 0.97) or renal failure (p = 0.56). AF was not a direct cause of death but served as a predictor of increased mortality and other complications. There were no differences in left atrial diameter (3.9 vs. 4.2 cm, p= 0.054) or LAVI (31 vs. 31.6 ml/m3, p= 0.635) between patients with and without postoperative AF, respectively.

Conclusion: Left atrial diameter and LAVI were not found to be significant independent predictors of postoperative AF. However, the development of AF was strongly associated with increased risks of mortality, cardiovascular complications, and congestive heart failure. These findings underscore that postoperative AF, while not a direct cause of death, is a critical marker of adverse outcomes following CABG

The Operative Correction of Pectus Deformities: A Prospective Cohort Study

Sun, 01 Mar 2026 00:00:00 +0200

Background: Pectus deformities represent the most common congenital chest wall abnormalities, significantly impacting both physiological function and psychological well-being of aﬀected patients. While multiple surgical approaches exist, the outcomes of surgical repair remain a subject of ongoing investigation. The objectives of this study were to evaluate the psychological impacts of pectus deformities with assessment of psychological satisfaction of the patient and his family post operative and assess improvements of physiological impacts of these deformities post operative

Methods: This prospective cohort study was conducted at xxxxx from 2022 to 2025. Fifty patients with pectus deformities underwent surgical correction using either the Modified Ravitch procedure (n=28, 56%) or the Nuss procedure (n=22, 44%). Outcomes included postoperative assessment scores (poor, fair, good, excellent), hospital stay duration, complications, and patient satisfaction.

Results: The study population consisted of 38 males (76%) and 12 females (24%) with a mean age of 14.8 ± 1.9 years. Pectus excavatum was the predominant deformity (86%, n=43), with pectus carinatum comprising 14% (n=7). Severity distribution showed 26% severe cases, with the remainder classified as moderate or mild. The overall excellent outcome rate was 42% (21/50), with 50% achieving good outcomes. Median hospital stay was 9 (8- 10) days, showing positive correlation with Haller index (r=0.33, p=0.026). The recurrence rate was low at 4% (2/50), and psychological satisfaction was achieved in 94% of patients.

Conclusions: Surgical techniques for pectus repair demonstrated high success rates with low morbidity. The Nuss procedure and Modified Ravitch procedure remains a reliable option with good to excellent outcomes in most cases.