Ultrafast-track extubation after pediatric cardiac surgery; benefits and safety

Background: Ultrafast-track extubation after cardiac surgery my facilitate rapid recovery. However, the overall risk-benefit is still debatable. The objective of this study was to report the effect of ultrafast-track extubation in pediatric patients undergoing cardiac surgery. Methods: This is a retrospective study that included 260 patients who had surgery for congenital heart diseases between 2015 and 2019. Patients were divided into two groups. Group A included patients who had ultrafast-track extubation protocol (n = 140), and group B was the conventional anesthesia group (n = 120). Results: The mean age was 3.68 ± 2.1 and 3.8 ± 1.6 years for groups A and B, respectively (p= 0.08). The total operative time was higher in group A (326± 18.15 vs. 274.6±28.1 minutes;  p 0.001), and the degree of pulmonary hypertension were higher in group B (p= 0.02). The rate of ventilator-related complications was higher in group B (P = 0.02). There was a significant reduction in mean length of intensive care unit stay between the ultrafast-track extubation and the conventional groups (65.3 ± 33.7 and 81.6±70.2 hours, respectively; p= 0.001). The total hospital stay was significantly reduced in group A (6.7 ± 2.7 vs. o 7.43±2.65 days for group  A and B, respectively, p= 0.03). Conclusions: The application of ultrafast-track extubation protocol could lead to a reduction in the ventilator-related complications, the length of intensive care unit and hospital stays without increasing postoperative complications

Short Term Outcome of Plasma Pleurodesis in Post Pulmonary Resections Persistent Air Leak

Background: Air leak is the most common morbidity after pulmonary resection surgery. It may result in prolonged duration with chest tubes with their annoying chest pain, prolonged hospital stay time with increased financial costs, pneumonia, empyema, and patient dissatisfaction. Our objective was to evaluate the efficacy of plasma pleurodesis for stoppage of air leak after lung resection, in comparison to conservative measures. Methods: This prospective single-blinded randomized study included 60 patients randomly divided into two groups: Group A: included 30 patients who received intrapleural fresh frozen plasma.  One bag of FFP, contains 250 ml of plasma, matched for the ABO group was installed through the apical chest tube into the pleural cavity. Group B: a control group of 30 patients who did not receive any sclerosing agent. They were managed with under-water seal and observation. Results: This study showed that the stoppage of air leak in group A was faster “which stopped in 9-10 days” in comparison to control group B “24-25 days”, (P-value <0.001). There was a significant difference between groups A and B regarding the hospital stay, which was in 9-10 days in group A in comparison to group B “26-28 days (P-value <0.001). Conclusion: Intrapleural fresh frozen plasma appears to be a valuable option to stop persistent air leaks post pulmonary resections. It’s a cheap, available, and safe agent. It reduced hospital stay, costs and morbidities

Predictors of Failure after DeVega Repair for Functional Tricuspid Regurgitation

Background: Untreated tricuspid regurgitation during mitral valve surgery may progress to severe symptomatic tricuspid regurgitation. Concomitant repair may increase the operative risk; however, re-operative tricuspid valve surgery is a high-risk procedure. This study's objective was to identify the predictors of DeVega repair failure in patients with functional tricuspid regurgitation and concomitant mitral valve surgery. Methods: This research is a retrospective comparative study that included 140 patients who underwent tricuspid valve repair concomitant with mitral valve replacement. We divided the patients into two groups; the first group (n=106) included patients with no DeVega failure at six-months follow-up (The sustained repair group). The second group included 34 patients who developed moderate or higher TR after the DeVega and was named the failed repair group. Results: The demographic data and comorbidities were not statistically different between both groups. The preoperative atrial fibrillation (73 (69%) vs. 30 (88%)’ p= 0.027) pulmonary artery pressure (64.8±3.6 vs. 81±6.5 mmHg; p= 0.02), right ventricular dimension (4.85±0.24 vs. 5.23±0.37 cm; p= 0.03), and time between the indication of surgery and operation (8.3 ± 3.1 vs. 14.7 ± 5.4 months; p = 0.003) were higher in patients with failed DeVega repair. There was no statistically significant difference regarding the mean bypass time, cross-clamp time, ICU and hospital stay, and postoperative complications between both groups. Predictors of failure after six months were preoperative heart failure (OR: 15.4 (95% CI: 3- 92.3); p= 0.003), long time between diagnosis and surgery (OR: 12.3 (95% CI: 2.1- 84.7); p= 0.007), and postoperative severe pulmonary hypertension (OR: 24.7 (95% CI: 3.1- 199.6); p= 0.003). Conclusions: DeVega repair is associated with a high failure rate after six months. The study of predictors of failure could change our management plans to reach the best results for repair

The Preoperative Use of Levosimendan in Patients undergoing Coronary Artery Bypass Surgery with Low Ejection Fraction

Background: Levosimendan is a calcium sensitizer with positive inotropic, vasodilatory, and cardioprotective actions. Levosimendan infusion time may affect the outcomes. Our objective was to evaluate its efficacy and safety when used before coronary artery bypass grafting (CABG) in patients with low ejection fraction. Methods: This prospective observational study included 150 CABG patients with ejection fraction ≤ 40% divided into two groups. In the Levosimendan group (n= 75), it was given preoperatively, and in the conventional group (n= 75), myocardial support was used if indicated. Results: Operative time (344±28.7 vs. 421.4±34.5 min) and cardiopulmonary bypass time (97±17.4 vs. 127.4±24.5) were significantly shorter in the Levosimendan group (P˂ 0.001, for both). Failure to wean from bypass (13 (17.3%) vs. 23 (30.7%), P=0.06) and the need for intra-aortic balloon pump (6 (8%) vs. 14 (18.7%), P= 0.06) were non significantly lower in the Levosimendan group. The mechanical ventilation duration (12±3.3 vs. 19.6±4.7 h, P= 0.04) and ICU stay (3.8±1.2 vs. 5.3±1.4 days, P ˂ 0.001) were lower with levosimendan. Mortality was non-significantly lower in the Levosimendan group (10 (13.3%) vs. 18 (24%), P= 0.09). There were no differences in atrial and ventricular arrhythmias between groups. Conclusion: The preoperative use of levosimendan could improve the outcomes in patients undergoing CABG with low ejection fraction. Levosimendan complication profile was comparable to the conventional approac

Modified Single-Patch Technique Versus Two-Patch Technique in Infants with Complete Atrioventricular Septal Defect

Background: There are many techniques in repairing complete atrioventricular septal defect including: double patch technique, classic single patch technique and modified single patch technique. It's still debated which of these techniques is superior to the other one, our objective was to contrast the outcomes following surgery between the modified single patch and double patch techniques for repair of complete atrioventricular septal defect. Methods: This study includes 100 infants who underwent complete atrioventricular septal defect repair. Individuals were split into patients repaired with modified single patch as group A (n= 50), and patients repaired with double patch as group B (n= 50). Results: Group B showed significantly higher Cardiopulmonary bypass time (110 ±12 vs. 88 ±8 min, P < 0.001) Aortic cross clamp time (81 ±7 vs. 61 ±5 min, P < 0.001), ICU stay (10 ±1 vs. 9 ±1 day, P < 0.001), hospital stay (17 ±2 vs. 15 ±1 day, P < 0.001), and drainage amount (310 ±98 vs. 194 ±80, P < 0.001). No changes observed among groups of the study in other operative or postoperative statistics. Conclusion: Modified single-patch repair and two-patch repair did not yield significantly different results in the total correction of atrioventricular septal defects