BASE DEFICIT IN IMMEDIATE POSTOPERATIVE PERIOD OF OPEN HEART SURGERY AND OUTCOME OF PATIENTS

Abstract- Base deficit is a non-respiratory indicator of acid base status. Aim of this study is to assess relationship between the base deficit value in immediate post operative period of CABG and valvular heart disease with cardiopulmonary and in hospital outcome of patient. A total of 136 consecutive with CABG and valvular heart disease scheduled in study. 20 variables were determined during the pre-intraand postoperative period. Statistical univariate analysis was performed differentiating patients whose initial base deficit after weaning from cardiopulmonary bypass was -8 meq and these whose base deficit was equal or more than -8 meq. Secondly a logistic regression model was performed on the variables shown to have a statistically significant difference in univariate analysis with determination of the odd ratio. 3 variables had a statistically significant difference in univariate analysis and 2 of them high lighted by the linear logistic model. The value of base deficit measured during the immediate postoperative open-heart surgery is correlated with volume of fresh frozen plasma and blood transfusion after open heart surgery and using of intra aortic balloon pump after surgery

Predictors of Atrial Fibrillation Following Coronary Artery Bypass Grafting

Background Atrial fibrillation (AF) is a frequent and serious complication of coronary artery bypass graft (CABG) surgery. Methods: We undertook a retrospective review of the records of patients undergoing CABG at Imam Ali Hospital between February 1, 2003 and February 1, 2006. The patients were divided in two groups, ie, Group A (AF) and Group B (no AF). The association between the occurrence of AF following CABG and other variables was compared with respect to continuous or categorical variables by t -test and χ 2 -test. Results Multivariate logistic regression analysis of potentially predictive factors in univariate analysis showed that opium use, type of operation, and crossclamp time were predictors of AF following CABG. Conclusion This study identifies some new predictors of postoperative AF, control of which could lead to a lower incidence of AF and reduced morbidity, mortality, and resource utilization for patients undergoing cardiac surgery

Base Deficit In the Immediate Postoperative Period of Open-Heart Surgery and Patient Outcome

Background:Base deficit is a non-respiratory indicator of acid base status that evaluates the severity of shock at the cellular level. Base deficit results from cellular metabolism of pyruvate under anaerobic conditions. In this situation, base deficit is a sensitive marker of the magnitude of anaerobic metabolism and tissue oxygen deficit[1].Several studies have shown a strong positive correlation between base deficit and the risk of morbidity and mortality in clinical situations such as circulatory shock, extracorporeal support and in children after operation for complex congenital heart disease. Methods: 136 consecutive cases with coronary artery disease and valvular heart disease were scheduled in the study. 20 variables were determined during the preoperative, intraoperative and postoperative periods. Statistical univariate analysis was performed differentiating patients whose initial base deficit after weaning from cardiopulmonary bypass was -8 meq and these whose base deficit was equal or more than -8 meq. Results: 39 patients had base deficit levels less than -8 (Group A) and 91 had a level of > -8 meq/L (Group B). Patients with a base deficit level of -8 meq/L or more were older and most of them were women. The prevalence of left ventricular ejection fraction less than 30% and coronary artery disease was not significantly higher in patients with base deficit of > -8 meq/L . No difference was found according to the presence of hypertension or diabetes in patients with base deficit levels of –8 or higher than in those with base deficit levels less than –8 (P >0.05). In the univariate analysis of preoperative variables, there were no differences with respect to factors such as age, sex, diabetes, preoperative hemoglobin level, hypertension, emergency operation and redo operation. Congestive heart failure was different between the two groups (P < 0.05).Three variables had a statistically significant difference in the univariate analysis and two of them were highlighted by the linear logistic model.Conclusion:The value of base deficit which was measured during the immediate postoperative open-heart surgery period is correlated with the volume of fresh frozen plasma and blood transfusion after open heart surgery and using of intra-aortic balloon pump after surgery

Aprotinin: Effects On Blood Loss And Fresh Frozen Plasma Requirement In Cardiac Operations

Background: Aprotinin has been used increasingly to reduce postoperative blood loss in open-heart operations; due to the potentialities for complications and high cost, it would seem reasonable to use aprotinin more selectively in small doses in the prime solution of the pump. Methods: We prospectively studied the effect of preoperative low dose aprotinin [2 million units (230mg)] on blood loss and transfusion requirements in patients undergoing cardiopulmonary bypass. One-hundred and fifty patients were randomly assigned to two groups: prophylactic low dose aprotinin (group 1) and a non-medicated control group (group 2). The two groups were comparable in all demographic and operative variables. Results: Postoperative chest tube drainage was significantly decreased in the aprotinin group compared with that in the control group (372.73 mL in group 1 and 482.2 mL in group 2, p<0.05). No significant difference was seen between the two groups in regard to transfusion requirement (p>0.05). The use of fresh frozen plasma (FFP) was significantly less in group 1 than in group 2 (469.87 mL versus 680.69 mL, p<0.05). Conclusion: Prophylactic use of low-dose aprotinin immediately before cardiopulmonary bypass reduced the need for transfusion of blood & fresh fro zen plasma (FFP) during the post operative period

Variables That Predict Reintubation After Open-Heart Surgery

Background:This study sought to determine patient characteristics, process of care,and outcome as predictors of reintubation after open-heart surgery.Methods:We performed a retrospective case control study that included all patients undergoing cardiac surgery who required reintubation and an equal number of control patients not requiring reintubation.Putative risk factors were analyzed univariately by Moses,Kroskal Willis and χ2 tests.Results: Of the 300 consecutive patients reviewed, 39 required reintubation for cardio- respiratory reasons. Univariate predictors of reintubation (P= 0.05) were preoperative CO2,ejection fraction,weight, diabetes, and intra-operative fluid balances. Multivariate predictors of reintubation for each group(with cardio-respiratory reasons) and for all patients were determined and included preoperative PaCO2, type of operation,ejection fraction (EF),pre- operative PaO2,number of grafts,age,intra-aortic balloon pump,pump time,clamp time,pH at extubation time,and PaO2 at extubation time.Conclusion:Patients who required reintubation had the worst respiratory function.Patients identified as having high risk factors for reintubation should be followed closely and treated for problems that will lead to reintubation

Clinical and laboratory patterns of the haemolytic uraemic syndrome and thrombotic thrombocytopenic purpura in southern Iran

OBJECTIVE: The haemolytic uraemic syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP) are rare disorders characterised by intravascular platelet aggregation and widespread thrombus formation in the microcirculation resulting in tissue ischaemia. A retrospective analysis was carried out in 136 patients with HUS or TTP hospitalized from April 1991 through March 2004 in three tertiary referral hospitals of Shiraz (the largest city in southern Iran) to evaluate the epidemiological aspects, clinical characteristics and laboratory findings of the two diseases. METHODS: One hundred and one cases of HUS (49 females and 52 males) and 35 cases of TTP (21 females and 14 males) were identified. The mean age was 3.5 years for HUS, 30.8 years for TTP. RESULTS: The mean annual incidence rate of HUS decreased approximately 30-fold throughout the observed period, while the incidence rate of TTP increased approximately 6-fold. A seasonal pattern was noted for both TTP and HUS, with the highest incidence during the summer months. Twenty patients with HUS and 16 patients with TTP died, resulting in case fatality rates of 19.8% and 45.7%, respectively. No prognostic factor was identified for TTP, whereas signs of neurological impairment and high leucocyte counts had an adverse effect on the prognosis of HUS patients. CONCLUSIONS: This study shows that, in contrast to other countries, the incidence rate of HUS shows a decreasing trend in southern Iran, probably related to the prevention of gastrointestinal diarrhoeal infections (especially Escherichia coli 0157:H7) and to their improved management. The incidence of TTP is increasing in Iran as in other countrie