فهرست مطالب evaz heydarpur

 Postoperative Acute renal failure related to cardiac surgery is a common complication due to cardiac surgery and is estimated to influence up to 30% of patients. Serum lactate is a famous biomarker of tissue ischemia and is regularly checked during surgery.

 In this retrospective observational research, the records of 395 patients undergoing CABG were examined. Patients were classified into 4 groups based on the difference between the maximum lactate level measured during surgery and its baseline level. Also creatinine and urea levels, blood sugar, hemoglobin, and hematocrit pre, postoperative were recorded. The intraoperative and postoperative use of inotropes and the durations of surgery, cardiopulmonary bypass pump, and aortic cross-clamping were also recorded.

 According to the results, pre, post and 24-hour postoperative blood urea nitrogen were not significantly related to intraoperative lactate changes. Also, pre and 24-hour postoperative creatinine had no significant relationship with intraoperative lactate changes, while postoperative creatinine was significantly associated with intraoperative lactate changes (P value=0.05). The duration of cardiopulmonary bypass (P value=0.02), intraoperative inotrope infusion (P value=0.03), inotrope infusion during the first six hours in ICU (P value=0.049), and receiving packed cell (P value=0.006) and receiving platelets during surgery (P value=0.04) were significantly related to intraoperative lactate changes. Furthermore, no significant relationship was observed between the duration of hospitalization in the ICU and the hospital and intraoperative lactate changes.

 According to the results, blood lactate level is an unreliable marker for predicting renal dysfunction postoperative.

Mediastinitis is a severe complication after cardiac surgery. The aim of this study was to determine the incidence of postoperative mediastinitis, the predictors of mediastinitis, and sternal dehiscence in adult cardiac surgery patients.

In this retrospective study, the records of 60 patients were evaluated regarding mediastinitis and dehiscence after cardiac surgery in a referral cardiovascular hospital in Tehran, Iran.

In the present study, 4360 patients underwent surgery over 18 months from September 2017 through March 2019. Of this total, 60 patients with a diagnosis of mediastinitis and sternal dehiscence were included in the study’s analysis. In our investigation, 1.03% of the cases (45/4360) had mediastinitis and 0.3% (15/4360) cases experienced sternal dehiscence. Among the many risk factors that were examined, there were significant differences between the mediastinitis and dehiscence groups regarding diabetes mellitus (P =0.007), a history of preoperative chronic kidney disease (P =0.02), a history of myocardial infarction (P =0.002), a history of arrhythmia before cardiac surgery (P =0.02), reoperation due to postoperative bleeding (P =0.07), the number of patients transferred to the ICU with the sternum left open (P <0.001), postoperative pulmonary complications (P =0.007), and postoperative arrhythmias (P =0.04).

There were significant differences between the mediastinitis and dehiscence groups regarding diabetes mellitus, a history of preoperative chronic kidney disease, myocardial infarction and arrhythmias before cardiac surgery, reoperation due to postoperative bleeding, the number of patients transferred to the ICU with the sternum left open, postoperative pulmonary complications, and postoperative arrhythmias. (Iranian Heart Journal 2021; 22(3): 6-12)

Reoperation due to bleeding in adult cardiac surgeries is an important postoperative complication that increases mortality and morbidity. Studying the risk factors and outcomes of reoperation in these patients is imperative.

The present descriptive (cross-sectional) study performed a 3-month assessment of patients that underwent elective cardiac surgeries (coronary or valve surgeries or both). The inclusion criterion was being an adult undergoing elective cardiac surgeries on cardiopulmonary bypass (coronary or valve surgeries or both), and the exclusion criteria consisted of congenital heart diseases, cardiac surgeries without cardiopulmonary bypass, emergency cardiac surgeries, aneurysm and aortic dissection surgeries, known causes of bleeding due to acquired or congenital diseases, and redo cardiac surgeries.

Of 740 patients studied, 55 (7.43%) patients returned to the operating room due to bleeding. Of these 55 patients, 74.5% had bleeding due to surgical operations, 23.6% due to tamponade, and 1.8% due to coagulation disorders. Apropos risk factors, there was a significant relationship between the international normalized ratio (INR) and bleeding after cardiac surgeries leading to reoperation (P = 0.05).

In this study, 7.43% of the patients returned to the operating room because of bleeding, which is an acceptable percentage according to the literature. There was a significant relationship between preoperative INR and postoperative bleeding resulting in reoperation. (Iranian Heart Journal 2020; 21(4): 85-92)