فهرست مطالب mohammadhosein mandegar

The occurrence of Atrial Fibrillation (AF) is linked to an increased inflam-matory response after cardiac surgery that is significantly decreased by anti-inflammatory treatments. The present study aimed at administrating Colchicine as a way to reduce the incidence of post- Coronary Artery Bypass Graft (CABG) atrial fibrillation. In this double-blind، parallel clinical trial، 216 patients with coronary artery disease who underwent CABG surgery، by using a table of random numbers are divided into intervention and control groups to receive placebo or Colchicine. The clinical and surgical characteristics of the patients in two groups were similar. The intervention group received 1. 0 mg of Colchicine tab، the night before surgery and on the morning of surgery. This drug followed by 0. 5 mg twice a day for five days after surgery. On the other hand patients in the control group received only placebo (ineffective pill with similar size to Colchicine). After operation two groups were compared regarding important outcomes such as postoperative arrhythmia، ICU stay and hospital stay. The data were assessed using SPSS software (version 17) and t-test and 2 statistical tests. One hundred fifty six men and sixty women with a mean age of 59. 9±9. 3 years were enrolled in the study in two Colchicine and placebo groups (each consisting of 108 patients). The incidence of postoperative atrial fibrillation was 14. 8% in the Col-chicine group and 30. 6% in the control group (P= 0. 006). ICU stay in the Colchicine group were 2. 4±1. 3 days versus 3. 1±1. 5 days in controls (P< 0. 001) and hospital stay in the Colchicine group were 6. 6±1. 5 days versus 8. 1±2. 0 days in controls (P< 0. 001). Colchicine is an anti-inflammatory medication and has very few side effects at low doses. According to the 48% reduction in the incidence of atrial fibrillation in Colchicine patients undergoing coronary artery bypass grafting surgery، this drug can be prescribed as a prophylaxis for prevention of post-CABG atrial fibrillation.

The benefits of using arterial grafts in coronary artery bypass grafting (CABG) have been elucidated in previous investigations. Alternative arterial grafts such as radial artery (RA) and right gastroepiploic artery (RGEA) have been used widely for CABG with increasing importance. Med-Line (1986-2010) was searched using the subsequent keyword arterial graft, CABG, RA and GEA. Overall, a total of 82 observational and comparison studies were considered relevant to this review and were summarized. This review provides a summary of the outcomes of RA and/or GEA arterial grafts regarding morbidity, mortality, patency rates, technical features and certain characteristics of the considered arterial conduits. This review article further supports the utility of the RA when used as either a composite or aortocoronary graft which results in improved results. Although some investigations showed acceptable results justify its use in clinical settings, there is still much concern about using the GEA in CABG. Right GEA, as an arterial graft, can be used as an in situ graft or a free graft.

Delayed sternal closure (DSC) has been shown to be useful following cardiac surgeries in case of indications including hemodynamic instability, noticeable myocardial edema, respiratory compromise, stubborn bleeding, placement of extracorporeal support device,and persistent arrhythmias. In this review, we summarize the investigations on this topic to analyze the controversial aspects of DSC in pediatrics and adults. Med-Line systematic review of the relevant literatures, which hase been published through 1970-2010, was performed. A total of 191 studies were identified, 62 of which were eventually deemed relevant to this review. According to proper indications, DSC has been used in several types of cardiac surgeries in pediatric (newborns, infants and children) and adult cardiac surgeries in recent 35 years. The outcomes concerning survival and complications seem to be acceptable. DSC is more frequent in pediatric cardiac surgery rather than adult cardiac surgery. DSC is an effective and safe strategy in patients with appropriate indications. Surgeons should be aware of its suitable use and also physiologic alterations and management of the patients when the sternum is still open. Several previous investigations showed wide variations in methods of DSC by institutions. Apparent differences in post-operative care of the patients with DSC clarify the demand for planning prospective multicenter trials with available control groups which can result in the implementation of standardized supervision protocols across institutions

A 30-year-old woman presented with doxorubicin-induced heart failure. She had been treated due to Ewing’s sarcoma five years ago. Traditional heart failure treatment has been performed but its effect was mostly very limits. We, therefore, decided to perform heart transplantation for her.

Major leg wound complications after coronary artery bypass graft procedures are infrequent and few are reported in the litrature.We present our experience in treating 30 patients with major leg wound complications after coronary revascularization procedures. A retrospective review of 2100 bypass procedures with saphenous veingraft performed over a 5-years period was conducted.15 potential risk factors for those who developed Major leg wound complications were analyzed and compared with the entire cohort of patients undergoing similar bypass procedures during the same period. lower extremity wound complications occurred in 30 patients (1.4%),19 of whom required additional surgical interventions.There were 6 wound debridments 2 skin grafts, 1angioplasty, 7fasciotomies,1embolectomy and fasciotomy 2 free tissue transfer. Of 14 variables evaluated by multivriate analysis, cardiopulmonary bypass time, duration of surgery and postoperative intraaortic ballon pump use were identified as significant independent predictors of major leg wound complications (p<0.05). The causes of major leg wound complications after saphenous vein harvest for coronary artery bypass graft procedures are multifactorial. To minimize these complications,we recommend vascular evaluations before saphenous vein harvest, attention to proper surgical tecnique,and careful harvest site selection.