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ObjectivesAtrial Septal Defect (ASD) accounts for 10% of congenital cardiac defects. The purpose of this retrospective study was to compare the short-term outcomes of surgical versus trans catheter closure of secundum atrial septal defect.MethodsThis is a single-center retrospective cohort study in patients who had surgical or trans catheter ASD closure. ASD closure outcomes such as hospital cost, length of hospital and ICU stay, residual ASDs, complications, readmission, hospital and three month mortality were recorded and compared.ResultsBetween March 2010 and March 2016, total of 102 secundum ASD patients were treated in our center (71 patients surgical ASD closure and 31 patients trans catheter ASD closure). About 13.9% of patients (5/36) in the device group had failed procedural attempt for various reasons and these patients underwent surgery closure. Complete closure was observed in 26 of 31 patients (83.9%) in the device group and in 70 of 71 patients in the surgery group (98.6%). The mean length of hospital stay was 5.56 days for surgical group and 2.06 days for device group. The procedure cost for surgery was found to be 5.7% lower than trans catheter closure (patient payment). The complication rates were 18.3% for surgical group and 25.8% for the device group. Readmission after discharge was more common in surgery group (11.2 vs 6.4%). Hospital and three months mortality in both groups were zero.ConclusionsBoth trans catheter and surgical procedure are good methods of successful ASD closure. Considering that the surgical group patients were higher risk patients, mean total hospital cost of patient's procedures were significantly higher in device closure group, failed intervention rate and residual ASD were more common in device group and complications of device group were more serious; thus, appropriate patient selection is an important factor for successful device closure.

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Background and aims: Coronary artery disease (CAD) is one of the main causes of death worldwide and coronary artery bypass grafting (CABG) surgery accounts for 1.4% of all operating room procedures. Considering the importance of the above-mentioned issue, the present study aimed to assess CAD risk factors in CABG patients to provide more accurate information for health authorities. Methods: To this end, data of all patients with isolated primary on-pump CABG were collected from March 2014 to March 2016. The major risk factors of CAD were recorded as a history of cigarette smoking, dyslipidemia, hypertension, diabetes mellitus (DM), advanced age, a family history of CAD, obesity, and male gender. Statistical analyses were performed by SPSS using a t test, as well as the chi-square and Fisher exact tests, and the P value less than 0.05 was considered statistically significant. Results: During a 24-month period, 895 patients underwent isolated primary on-pump CABG in the only open-heart surgery center in the West Azerbaijan province of Iran. The mean age of the patients was 60.4±10.3 years (within the range of 40 to 93 years). In addition, most of the patients amounting to 525 cases (58.7%) were in the age group of 55-70 years and had two or more risk factors. Further, 98.8% of males (age ≥45) and 68.2% of females (age ≥ 55) were old, and 73.3% and 26.7% of the patients were men and women, respectively. Furthermore, risk factors such as hypertension, cigarette-smoking, DM, hyperlipidemia, obesity, and family history were observed in 53.3%, 47.9%, 37.8%, 28.5%, 61.1%, and 19.3% of the patients, respectively. As regards gender, the prevalence of coronary risk factors like hypertension (60.7 vs. 50.6%, P=0.005), DM (51.9 vs. 32.6%, P=0.001), hypercholesterolemia (43.5 vs. 23%, P=0.001), and obesity (68.2 vs. 58.5%, P=0.005) were higher in women but other factors such as smoking (19.2 vs. 58.4%, P=0.001) and positive family history (14.6 vs. 21%, P=0.01) were higher in men. Conclusion: Overall, the prevalence of most risk factors was more common among under 55-year group, especially in women, and this is a warning for increasing CADs in the future

Introduction:Since coronary artery angina pectoris is a chronic disease, it negatively affects patients` self-concept. In this study, the effect of follow-up care on the self-concept of patients undergoing coronary artery bypass grafting was investigated. Moghaddam et al.; JPRI, 32(1): 57-63, 2020; Article no.JPRI.54693 58 Materials and Methodology: In this study, the clinical trial was measured using self-concept questionnaire considering the effect of follow-up or constant care on 60 patients under coronary artery bypass grafting in Seyed-al-shohada heart center of Urmia. Eight to twelve weeks after the operation, the follow-up care, which is an Iranian native model was administered through telephon. Data collection tools included patients` demographic data collection form as well as self-concept questionnaire consisting of 25 Likert-scale items of 1 to 5 (totally positive, positive, neutral, negative, totally negative), which measured 25 features. Original Research ArticleResults: In the current study, the mean age of patients in both groups (intervention and control) was 59.68±7.43 and 59.48±5.79 years old, respectively. In addition, the mean weight of patients in both groups (intervention and control) equaled 77.82±10.67 and 75.22±7.53 kg. According to the results of the mean, the perceived threat after the intervention was 45.16±4.28 in the intervention group and it was 40.43±5.22 in the control group, showing a significant statistical difference between two groups (p<0.001). The perceived challenge after the intervention was 70.86±6.82 in the intervention group and it was 67.13±6.37 in the control group, showing a significant statistical difference between two groups (p=0.028). Conclusion:The mean of self-concept score increased after the intervention and the observed results could have positive effects on the treatment of patients.

Warfarin is a commonly-prescribed anticoagulant used to treat and prevent thromboembolic events. The requirement for varying doses of warfarin depends on genetic and environmental components. In this study, the frequency of two single-nucleotide polymorphic variants of the vitamin K epoxide reductase complex subunit 1 (VKORC1) gene (1173 C>T (rs9934438) and 3730 G>A (rs7294)) and its correlation with warfarin maintenance doses were investigated in patients with heart valve replacement from West Azarbayejan, Iran. Blood samples were obtained from 185 patients; their genomic DNA was extracted and samples were genotyped by polymerase chain reactionrestriction fragment length polymorphism (PCR-RFLP) assay. To assess if the blood warfarin level is different among genotypes, we used a one-way analysis of variance (ANOVA) followed by a Tukey's post-hoc comparison. The minor allele frequency was determined to be 54% for 1173T and 53.7% for 3730A. Patients who carried the G allele at position 3730 and T allele at position 1173 required a significantly lower daily mean warfarin dosage (P <0.001). Consideration of the VKORC1 gene polymorphism, especially at the initial stages of the therapy, can be helpful in pretreatment dosing of warfarin, which, in turn, reduces the adverse effects resulting from inappropriate drug prescription.

Background: Statins have recently been suggested to exert protective cerebral effects in patients undergoing cardiac surgery. Objective: The aim of this study was to determine the association between pre-operative statin administration and the rate of post-operative delirium (POD) in patients undergoing coronary artery bypass grafting (CABG). Methods: This prospective cohort study was conducted at Seyedoshohada Hospital (Urmia, Iran) from June 2017 through April 2018. Patients, before undergoing CABG may have two different approaches by clinicians; administrating statins vs. those who do not receive statins. Participants in this study were selected among each of the two approaches. Therefore, Group A (n=200) (exposure group) received statins 10 mg or 20 mg in the preoperative period and Group B (n=200) did not receive statins before admission to hospital. During their intensive care unit (ICU) stay, Confusion Assessment Method (CAM) was performed every 8 hours to assess delirium. The data were analyzed by STATA version 13. The rate of POD were determined across the groups using independent samples t-test and Chi-square tests. Study covariates were adjusted and the association between the outcome of delirium incidence and clinical interventions was examined using multiple logistic regression. Results: Demographic data was similar between the two groups. Of the four hundred patients analyzed, 57 patients (14.5%) had delirium at some time during their cardiovascular ICU stay; nine (4.5%) in the patients group with use of statins and forty-eight (24%) in the patients group without use of statins had POD. There was a significant difference in the occurrence of delirium across the two groups (p=0.001). Incidence of POD in patients ≥ 60 years in Group A was significantly lower than in the patients in Group B, 4.2% and 32.3% respectively (p=0.001). Conclusion: Statin Pretreatment reduces the occurrence of post-operative delirium after coronary artery bypass surgery.