No abstract

Background: Myocardial infarction that occurs during surgery for cardiac patients is still a difficult issue that raises morbidity and mortality. Clinical investigations demonstrate that nocturnal melatonin secretion is lowered in individuals with Alzheimer's disease, coronary heart disease, and stroke, although the pathophysiologic implications of altered melatonin secretion remain unclear. Aim: The current study aimed to evaluate the protective role of melatonin in improving the degree of cardiac injury in patients undergoing bypass surgery.Patients & Methods: This is a randomized control clinical study, which took place in Suez Canal University Hospital in the routine surgical theaters. Following the departmental research committee approval and informed patient's consent, 74 patients, undergoing CABG surgery were randomly allocated to one of the two groups using a table of random numbers: group M received 10 mg melatonin orally for two nights pre-operative as a study group, and group C received placebo orally for two nights pre-operative as a control group. Results: Our result presented a substantial difference between the control and melatonin groups in postcardiopulmonary bypass heart rate, cardiac injury enzymes as cTnI and CK MB levels, new wall motion abnormalities, cardiac systolic function EF %, and post-operative ventilation time. Conclusion: Administration of oral melatonin hormone 10 mg for two nights pre-operative can decrease myocardial I/R injury and improve outcome after CABG surgery by increasing cardiac systolic function EF%, decreasing cardiac wall motion abnormalities, decreasing cardiac injury biomarkers (CK -MB and troponin I) and decrease post-operative ventilation duration.

Objectives: Patients with impaired renal functions have a variable risk of morbidity and mortality in cardiovascular surgery. Poor outcome was reported among patients who underwent valve surgery. Current study is presumed to compare the early outcomes of patients having different degrees of impaired renal functions and undergoing mitral valve replacement surgery. Methods: 135 patients were admitted into the three highly specialized centers in Cairo and Ismailia–Egypt between Dec.2018 and Jan.2020 Preoperative, intraoperative and early post-operative data were recorded. Impairment may present as one of these strata: early reversible (G1-2 included strata 1 & 2 kidney disease patients), moderate G3-4 included strata 3 & 4 kidney disease patients) or advanced irreversible renal damage. (The 5th stratum or G5-KD included end stage renal disease patients undergoing 4-hour hemodialysis sessions, three times a week, with bicarbonate dialysate). We correlated outcome among each stratum with cardiac and renal functions in that stratum. Results: The more is the impairment of renal functions at any peri- operative stage, the longer is the need for prolonged mechanical ventilation and the longer is the hospital stay. We found that levels of serum creatinine were significantly increased postoperatively Also, the more is the reversibility of the renal impairment, even by renal dialysis, the much better is the outcome (P=.0019). We also found insignificant difference between different strata of irreversible renal impairment in the early outcome of the prosthetic mitral valve replacement surgery. The early reversible damage can be repaired peri-operatively. Conclusions: Prosthetic mitral valve replacement among patients with different degrees of impaired renal functions is not only feasible but also it does not seem to add any more deterioration into renal function. Prolonged mechanical ventilation and hospital stay are the only drawbacks of irreversibly impaired renal damage by dialysis or renal transplant.

No abstract