ObjectiveIt is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting.MethodsFrom December 2013 to November 2015, 80 consecutive patients underwent primary isolated CABG surgery at national heart institute, their data were prospectively collected and they were classified according to their HbA1c level into two groups, Group (A): Forty patients with fair glycemic control (HbA1c below or equal to 7%), Group (B): Forty patients with poor glycemic control (HbA1c above 7%). Hospital morbidity, mortality and one year survival were examined in both groups. Telephone conversation was used to call patients or their relatives to determine the one year survival and it was 100% complete. This study had gained the ethical approval from national heart institute ethical committee.ResultsIn-hospital mortality for group A was 2.5% (one patient) and 7.5% (3 patients) for group B with no statistical significance. One year mortality was (5.13%) (2 patients for group A) and (8.11%) (3 patients) for group B with no statistical significance. As regard the morbidity there was no statistical significance between the two groups in the incidence of neurological complications whether stroke or coma, atrial fibrillation, postoperative myocardial infarction, low cardiac output syndrome, heart failure, renal failure, need for dialysis, deep sternal wound infection, and readmission. However, group B had lengthy hospital stay, lengthy ventilation hours, more respiratory complications, and more superficial wound infection with a statistical significance when compared to group A, P values were 0.003, 0.003, 0.038, 0.044 respectively.ConclusionsThis study showed that HbA1c is a good predictor of in-hospital morbidity. It worth devoting time and effort to decrease HbA1c level below 7% to decrease possible postoperative complications.
Background: Rheumatic heart disease (RHD) is the leading cause of mitral valve disease in the developing world. In general, mitral valve repair is preferred over replacement. Although it is very successful in degenerative disease, its results in the rheumatic valve are not as successful as that for degenerative repair. Our approach has been to repair rheumatic mitral valves when the anatomic substrate appears to permit it, and we aimed by this study to present our immediate and midterm follow-ups of our cohort of rheumatic valve repair patients. Methods: From February 2011 to March 2013, 52 consecutive patients underwent mitral valve repair for rheumatic disease with different surgical techniques at the National Heart Institute of Egypt. Patients who had concomitant aortic or coronary artery bypass surgery were excluded. Also, patients needing an emergency operation or redo ones were excluded. On the contrary, patients who had concomitant tricuspid valve surgery were included. Demographic, intraoperative, and perioperative outcome data were recorded prospectively. All patients underwent TTE before hospital discharge. During follow-up, patients were contacted by telephone and invited for follow-up TTE yearly after their operations. Results: Fifty-two patients with rheumatic disease underwent mitral repair. Their mean age was 25.92 ± 9.81 years. The study population was 78.8% female. Forty-nine patients were in New York Heart Association functional class III or IV. Repair procedures included implantation of Carpentier-Edwards Classic mitral annuloplasty ring (100% of the whole study group). Mitral commissurotomy and repair of the subvalvular apparatus were generally performed. Thirteen neochordae were implanted. Anterior leaflet extension with an autologous pericardial patch was used in 4 patients; annular decalcification, in 2 patients; tricuspid repair with De Vega technique, in 18 patients (34.5%); and repair with Carpentier-Edwards Classic tricuspid annuloplasty ring, in 9 (17.3%) patients. There was no operative mortality. The mean follow-up time was 59.9 ± 5 postoperative months (range, 49-60 months). Only 2 patients (3.8%) died. Follow-up echocardiography revealed more-than-or-equal-to-moderate (2+) grade of MR in 5 patients. During the follow-up period, the mean LV end-diastolic diameter decreased significantly from 5.57 ± 1.06 cm to 4.93 ± 0.74 cm (<0.001). The mean pulmonary artery pressure decreased from 44.94 ± 17.01 mmHg to 35.69 ± 7.92 mmHg postoperatively (P < .001). The mean mitral valve area increased from 1.2 ± 0.9 cm2 to 2.3 ± 0.2 cm2 postoperatively (P < .001). The mean mitral valve gradient decreased significantly from 12 ± 4.9 mmHg to 4.3 ± 1.9 mmHg postoperatively (P < .001). The mean MR grade decreased from 3.73 ± 0.45 to 0.96 ± 1.08 postoperatively (P < .001). Conclusion: We conclude that repair is possible in patients with rheumatic mitral valve dysfunction. Current techniques with some modifications can be efficient to restore both the anatomy and physiology (better function) of the mitral valve and can lead to favorable early and midterm outcomes. We, therefore, recommend that the number of rheumatic mitral repair procedures should be increased in developing countries to achieve the best results.
Purpose: In comparison to transfemoral approach, transradial access (TRA) has developed to be the conventional entry site and is quickly expanding. Radial artery occlusion (RAO) which can occur during transradial intervention, impairs radial artery (RA) to be the future access site, and prohibits the artery from being used as an arterial conduit. Aim of this research was comparing incidence and predictors of RAO among individuals receiving elective cardiac catheterization by conventional radial access vs distal radial access. Methodology: This prospective study enrolled 120 patients from June 2022 to January 2023 (84 males, 36 females; mean age 68.5 (10.4) years with 62 patients had elective cardiac catheterization via conventional radial approach (CRA) and others via distal radial approach (DRA). Clinical follow up at 24 hours and 30 days was recorded with analysis of the incidence and predictors of RAO among all included participants. Findings: This study reported no substantial difference among groups in terms of socio-demographic and clinical characteristics. Time to sheath insertion and Procedure time were long among patients who had Distal radial approach with statistically significant difference (P <0.01). Moreover, RAO at 24 hours and 30 days follow up was higher among patients had CRA than those had DRA with no significant difference (P >0.05). This research demonstrated that RAO incidence was significantly high among younger patients, smoker, DM and those with previous CAD. Also, time to sheath insertion and hemostasis were long in patients with RAO with statistically significant difference (P <0.05). Smoking, DM, long Procedure time and increased time to hemostasis with diminished blood supply in wrist throughout hemostasis were strong predictors for radial artery occlusion. Recommendations: Maintaining radial patency must be done with all procedures using the radial approach. DRA may be useful to lower RAO incidence through shortening hemostasis time and sustaining radial artery flow during hemostasis. Encouraging the interventional cardiologists for more practicing about utilizing DRA was recommended due to its advantages like safety with less vascular complications.
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