Post-sternotomy infections are a kind of nosocomial infection involving the mediastinum space and the sternum, with a high morbidity and mortality rate. The present study was carried out to identify the incidence of mediastinitis following cardiac surgery and the most common risk factors. Cardic patients undergoing surgery were studied for suspicious mediastinitis infection at the Madani Heart Center, Tabriz, Iran from 2004 to 2006. The most common isolated agents included the coagulase-negative staphylococci, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacter spp. Incidence of postoperative mediastinitis after cardiac surgery was 1.2%. The mortality rate of postoperative mediastinitis was high (34.3%). Wound infection, especially mediastinitis following cardiac surgery, is rare but could be life-threatening. The most important step in the management of wound infections is prevention, and preventive measures could be strengthened by identifying the risk factors.

Cardiac lipomas are rarely encountered. They are mostly asymptomatic and may be discovered incidentally. We describe the case of a 56 year-old man with a presentation similar to tamponade. He had decreased heart sounds, global cardiomegaly, and oligemic lung fields. Echocardiography showed a 110 × 75-mm mass attached to the interatrial septum, almost completely occupying the right atrium. Chest computed tomography showed a large homogeneous low-attenuation mass with thin septa, originating from interatrial septum and filling the right atrium, consistent with lipoma. The patient underwent surgery for resection of the tumor. Pathologic examination was consistent with cardiac lipoma.

Background Historically, coronary artery bypass grafting is associated with a higher mortality rate in patients with severe heart failure. This study aimed to assess the in-hospital mortality of CABG in patients with severe heart failure in Iranian patients and to identify factors associated with adverse outcomes. Methods This retrospective descriptive study enrolled patients with severe heart failure who underwent coronary artery bypass surgery from 2015 to 2020 in Madani Hospital, affiliated with Tabriz University of Medical Sciences. Results A total of 865 consecutive patients with a mean age of 60.65 ± 10.00 were enrolled in the study. Of all participants, 175 were female (20.4%), and 684 were male. The overall mortality rate was 9.5%. In the univariate analysis, predictors of ICU mortality were age, female sex, DM, and renal failure (P value < 0.05). None of the factors studied was an independent predictor of ICU mortality in the multivariate analysis. Conclusion This study established that although coronary artery bypass surgery is reported to have low mortality and postoperative morbidity in patients with severe heart failure, there are still centers that face higher mortality rates in these patients. Improving these patients' outcomes would be possible through identifying the associated risk factors and pre-and postoperative management.

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Objectives: Aortic dissections of type A are clinical emergencies that can prove fatal if not managed promptly in specialized care facilities. Poor clinical management is the cause of approximately 1% of deaths in patients; however, with advances in clinical practice, diagnostic imaging and clinician awareness, the mortality rate has been dramatically reduced to below 30% in most international centers. We examined the potential factors involved in mortality after surgery for type A dissections. Methods: In this descriptive-analytical study, patients who underwent acute aortic dissection surgery in the Shahid Madani Hospital of Tabriz, Iran, between March 2009 and March 2020 were evaluated. Exclusion criteria included those who died before the surgery, patients with descending aortic dissection, and high-risk patients for surgery who were candidates for medical treatment. Among 185 operated patients, 137 were included. Males comprised 62.8% of the patients. Their mean (±SD) age was 53.9 (±15.3) years. Results: Age (p-value < 0.0001), the presence of hypertension (p-value = 0.015), the amount of packed red blood cell transfusion (p-value = 0.024) and the amount of platelet transfusion (p-value = 0.018) were associated with increased mortality. Duration of intubation, use of fresh frozen plasma, postoperative drainage, duration of intensive care unit recovery, high serum creatinine, duration of aortic clamping, brain protection method, and smoking were not associated with increased mortality. Conclusions: These findings suggest that participants' mortality is dependent on several variables. Mortality of the patients with type A dissection can be reduced by interventions and reducing those factors.

Temporary pacemaker wires are commonly used for the diagnosis and treatment of arrhythmias in the acute postoperative period. We herein describe a 65-year-old woman with a history of coronary artery bypass graft surgery who was referred to the hospital with a purulent discharge in the lower third of the sternal region while on antibiotics. Two years later, following treatment failure, 2 sternal wires were removed. Several years after the surgery, the patient developed a purulent discharge. On suspicion of rib osteomyelitis, the last left cartilage attached to the sternum was excised and removed together with an infectious tract. During the operation, the right ventricle was torn, and tampons were used to control bleeding. The patient was placed under cardiopulmonary bypass via the cannulation of the left femoral artery and the right femoral vein. The sternum was opened, and the rupture site was repaired. A temporary epicardial pacing wire was found at the site of the right ventricular rupture.  Several days later, the patient was taken from the intensive care unit to the operating room due to a pulsatile hematoma in the left groin and a diagnosis of a pseudoaneurysm of the femoral artery. After a week, the purulent discharge at the lower sternum improved, and the patient was discharged. At 1 month’s post-discharge follow-up, the infection was eradicated

Redo cardiac surgery is usually more complex than initial surgery and has a higher risk of mortality due to the risks associated with sternotomy. Thoracotomy is a procedure through which easy access to the heart and valves is possible, taking less time. There is no need to release the adhesions of the previous operation. In addition, there is no possibility of heart rupture and unstable hemodynamics in the second CABG operation. Safe peripheral Cardiopulmonary bypass (CPB) access and right thoracotomy are preferred in patients with unstable hemodynamics with a history of CABG and mitral valve replacement (MVR) surgery. A 60 -year old man with a history of prosthetic MVR, CABG, and right-hand paresis due to cerebrovascular accident (CVA) was referred to Madani Hospital in Tabriz, Iran (2020). Transthoracic echocardiography (TTE) revealed signs of severe dysfunction of the prosthetic mitral valve (PMV). Whereas, on anticoagulation, a left ventricular ejection fraction (LVEF) was about 40%, and the patient had mild to moderate aortic regurgitation (AI). The patient underwent an emergency redo MVR operation using the thoracotomy techniques and coronary intervention (hybrid procedure). After two weeks, TTE showed a decreased mobility of one PMV leaflet, and the patient did not respond to full anticoagulation. Therefore, the third surgery was performed.

Subcutaneous emphysema occurs when air is trapped between subcutaneous tissues and manifests as sudden swelling, dysphonia, and sore throat. In many severe cases, subcutaneous emphysema causes dysphagia, pain, and breathing difficulty. The current study reports two cases of successful management of extensive subcutaneous emphysema after cardiac surgery. The first patient was a 60-year-old man with a history of coronary artery disease who underwent coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass. He was transferred to the intensive care unit (ICU) in good condition. Twelve hours after the surgery, he was extubated in a stable condition. On the second day after the surgery, his face, neck, and chest began to swell due to extensive subcutaneous emphysema, and he experienced decreased SPO2 and severe respiratory distress. The second patient was a 65-year-old woman with a history of myocardial infarction (MI) who had CABG off-pump surgery. After surgery, the patient was transferred to the ICU in a favorable and stable condition and was extubated 6 hours after the surgery. Her face, neck, and chest started swelling three days after the surgery, and she had severe respiratory distress and decreased blood saturation due to extensive subcutaneous emphysema. In both cases, despite conventional treatment, the patient's symptoms escalated despite re-intubation and mechanical ventilation.In the operating room, the chest tubes were removed, two new chest tubes were inserted, and the area damaged by the old tubes was repaired. Shortly after the insertion of the chest tubes, the patient's emphysema symptoms decreased significantly.