9. Prevalence and impact of carotid disease in adult Saudi patients undergoing isolated coronary artery bypass surgery on early post-operative outcome

Assess the prevalence of carotid disease in our Saudi population undergoing coronary artery bypass surgery and determine its impact on stroke and early post-operative outcome. Materials & Methods: 3197 consecutive adult patients underwent major cardiac surgery in our center between January 2002 and December 2012. 3150 of these had preoperative duplex scanning, and out of these, 210 patients (6.6%) had significant carotid artery disease defined as ⩾75% stenosis (Group A), while 2940 (94.4%) were free from carotid artery disease (Group B). Both groups were compared for presence of pre-operative risk factors and for occurrence of adverse events in the immediate post-operative period. Results: In uni-variant analysis, pre-operative risk factors for the presence of carotid artery stenosis were diabetes mellitus (p < 0.0001); hypertension (p < 0.0001); past cerebrovascular accident (p < 0.0001) and peripheral vascular disease (p < 0.0001). All-cause in hospital mortality was high in group A in comparison to group B (3.8% vs 1.56%; p = 0.004). The Morbidity was also high in group A compared to group B in terms of stroke (4.3% vs 1.6%; p = 0.0014), nosocomial pneumonia (16.4% vs 8.9%; p = 0.0015), leg wound infection (14.2% vs 6%; p = 0.0001), septicemia (9.3% vs 4.8%; p = 0.013), acute limb ischemia (1.1% vs 0.4%; p = 0.034), new-onset atrial fibrillation (26.8% vs 16.3%; p = 0.0005), ventricular fibrillation (4.9% vs 1.5%; p = 0.0035) and renal dysfunction (11% vs 4.9%; p = 0.0017). Conclusion: The Presence of carotid artery disease in Saudi patients undergoing cardiac surgery is associated with increased prevalence of diabetes, hypertension, cerebro-vascular accidents and peripheral vascular disease. It is also a major determinant of adverse outcome after coronary surgery

3. The impact of elevated HbA1c on Surgical Site Infection and other infectious morbidities after isolated coronary artery bypass surgery

Wound infection is an important cause of morbidity and mortality after coronary artery bypass surgery (CABG). Patients with diabetes represent a high risk group for patients undergoing CABG. Glycosylated hemoglobin (HbA1c), a measure of hyperglycemia, is a sensitive and reliable marker of impaired glucose metabolism. The aim of the study is to compare the impact of the elevated (HbA1c), on the post-operative risk of Surgical Site Infection (SSI) and other infectious morbidities and mortality after isolated CABG. Patients & methods: Two hundred and fifty patients (190 males, 65 females; mean age 62.69 ± 11.00; range 38–85 years) who underwent coronary artery bypass surgery at our center between January and December 2012 were enrolled in this study. All patients including the non-diabetics were managed with a specialized hospital protocol for glycemic control in the perioperative period. Results: Out of the 255 patients, 169 patients (66.3%) had elevated preoperative HbA1c and 183 (71.8%), were diabetics. Surgical Site infection were observed in 26 patients with elevated HbA1c and 2 patients in the normal HbA1c group respectively (15. 3% vs 3.6%, p = 0.002), Pneumonia, were observed in 11 in the elevated and 3 in the normal HbA1c respectively (6.5% vs 5.5%), Furthermore, Septicemia was observed in 3 patients (1.8%) with elevated HbA1c. The 30 days mortality was Zero in both groups. Conclusion: Our cohorts of patients have a high incidence of diabetes, and 66.3% of the patients have elevated HbA1c at the time of surgery. Patients with elevated HbA1c, undergoing isolated coronary artery bypass surgery have a significantly higher risk of surgical site infection and may have a higher risk of other infectious complications, but have no impact on early mortality