Emad M. Hijazi

Aspirin does not increase bleeding and allogeneic blood transfusion in coronary artery surgery.

BACKGROUND Traditionally, the administration of aspirin is stopped seven days before coronary artery bypass surgery to reduce the risk of postoperative bleeding. The aim of this study was to evaluate the effect of preoperative aspirin on bleeding in these patients. METHODS A prospective nonrandomized unblinded study was carried out at the King Abdullah University Hospital in Jordan/Irbid from June 2005 to December 2009 in 756 patients. Patients were divided into 2 groups: Group 1 (n = 400) consisted of patients on aspirin, 100 mg/day, until the day of surgery; Group 2 (n = 356) consisted of patients who stopped taking aspirin seven days before surgery. The groups were compared to evaluate the effect of preoperative aspirin on bleeding in patients undergoing elective coronary artery bypass surgery. Data were collected and compared and included total amount of postoperative chest tube drainage, number of transfused units of blood and blood products, and numbers of patients who required reexploration for bleeding. Results were considered significant when P < 0.05. RESULTS There was no significant increase in the amount of blood loss, units of transfused blood products, or the incidence of reexploration between the two groups ( P > 0.05). CONCLUSION Aspirin does not increase bleeding or increase the need for allogeneic blood transfusion in coronary artery surgery.

Comparative study of traditional long incision vein harvesting and multiple incisions with small skin bridges in patients with coronary artery bypass grafting at King Abdullah University Hospital--Jordan.

OBJECTIVE Saphenous vein harvesting can be associated with wound complications, incision pain, infection, and poor cosmetic outcome. The objective of our study is to determine the difference in wound complication and infection rates between two saphenous vein harvesting techniques, long incision versus multiple short interrupted incisions (tunneling) for coronary artery bypass grafting at the King Abdullah University Hospital--Jordan. METHODS Retrospectively we analyzed data from 1,050 consecutive elective coronary artery bypass procedures performed from May 5, 2003, to December 31, 2007, in our institution. Saphenectomy using traditional Long incision vein harvesting (Group 1) performed in six hundred and fifty patients (n=650), while saphenectomy using multiple incisions with small skin bridges--tunneling (Group 2) performed in four hundred patients (n=400). Saphenectomy performed by the cardiac surgery assistant or main cardiac surgeon. Inflammation, dehiscence, cellulites, lymphangitis, drainage, necrosis, or abscess necessitating dressing, antibiotics or debridement before complete healing without eschar were defined as wound complications. There was no statistical difference in preoperative risk factors in both groups. Test results were considered significant when P<0.05. RESULTS Leg wound complications observed more in traditional long incision vein harvesting technique (P=0.0005). Female gender, obesity, diabetes are associated with an increased incidence of wound problems (P<0.05). CONCLUSIONS Saphenous vein harvest using saphenous vein tunneling was associated with fewer wound complications than the traditional longitudinal method.

Is it time to adopt beating-heart coronary artery bypass grafting? A review of literature

Avoiding the morbidity of cardiopulmonary bypass should theoretically reduce the incidence of organ dysfunction and lead to improved patient outcomes. Recently, cardiac mechanical stabilization techniques were developed, facilitating on-pump CABG (OPCAB). The use of CPB may influence the economic outcome, while maintaining quality of care and patient satisfaction. MEDLINE, EMBASE, Cochrane Controlled Trials Register (CCTR), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), Science Citation Index (SCI), Current Contents, NHS Economic Evaluation Database (NEED), and International Network of Agencies for Health Technology Assessment (INAHTA) databases were searched from the date of their inception to the end of March 2008, using the search terms off-pump, minimally invasive, beating heart, coronary artery bypass, and their variants. Off-pump revascularization offers a safe, cost-effective alternative to conventional coronary revascularization with cardiopulmonary bypass (CABG) and cardioplegic arrest.

Incidence of Nausea and Vomiting After Fast-Track Anaesthesia for Heart Surgery

Objective The aim of this study was to evaluate the incidence of postoperative nausea and vomiting (PONV) after fast-track cardiac anesthesia (FTCA) in the first 24-48 hours in the cardiac intensive care unit (CICU) after open-heart surgery, risk factors for PONV and its influence on CICU length of stay. Methods A prospective observational study from January 1, 2013 to the end of December 2015 was performed in the CICU of a university hospital in the north of Jordan and Queen Alia Heart Institute, Amman, Jordan. Three hundred consecutive patients undergoing fast-track cardiac anesthesia in elective cardiac surgery were enrolled in the study. Nausea and vomiting were assessed after tracheal extubation, which was performed within 6-10 hours after surgery and during the first 24-48 hours in the CICU. Metoclopramide 10 mg intravenously was used as the initial antiemetic drug, but ondansetron 4 mg intravenously was also used as second line of management. Results Nausea was reported in 46 (15.3%) patients, and vomiting in 31 (10.3%). Among females, 38 (33.9%) patients developed nausea and 20 (17.9%) developed vomiting. Among males, 8 (4.3%) patients developed nausea and 11 (5.9%) developed vomiting. Conclusion PONV are relatively low after FTCA and the prophylactic administration of antiemetic drug before anesthesia or after extubation is not necessary.

Inhibition of SA Node at Supine Position in Right Atrial Thrombus Complicating Behçet's Disease - From Cardiac Surgical Point of View.

Patient: Female, 27 Final Diagnosis: Right atrial thrombus compressing the sinoatrial node Symptoms: Dyspnea • cough and hemoptysis with supine bradycardia reaching 36/min and dizziness Medication: — Clinical Procedure: Cardiac surgical intervention removing the mechanical cause if conservative management failed can be done safely Specialty: Surgery Objective: Rare disease Background: Behçet’s disease (BD) is a chronic multi-systemic disease of unknown cause. Intra-cardiac thrombus (ICT) complicating BD is extremely rare. In general, cardiac manifestations in BD are associated with poor prognosis. Chest computed tomography (CT) scan and echocardiogram are excellent modalities for diagnosis and patient assessment. Cardiac surgical intervention can be done safely using an on-pump technique when medical management has failed. Case Report: We report on a case of a 27-year-old Jordanian woman diagnosed with BD who presented with dyspnea, cough, and hemoptysis, with supine bradycardia reaching 36 beats/minute and dizziness which disappear on sitting or standing position, and with heart rate reaching 76 beats/minute. Right atrial thrombus was identified using transthoracic echocardiogram and chest CT scan. After medical management failed, cardiac surgical intervention became an option and targeted extraction of the right atrial thrombus compressing the sinoatrial node (SA node). Conclusions: In BD, right atrial thrombus compressing the SA node is rare. If conservative management has failed, cardiac surgical intervention removing the mechanical cause can be done safely, either using on-pump with cross clamp or on-pump with beating heart technique.