Mehdi Hadadzadeh

During off-pump coronary artery bypass (OPCAB), the heart is subjected to ischemic and reperfusion injury. Preconditioning is a mechanism that permits the heart to tolerate myocardial ischemia. The aim of this study was to compare the effects of Adenosine preconditioning with ischemic preconditioning on the global ejection fraction (EF) in patients undergoing OPCAB. In this single-blind, randomized controlled trial, sixty patients undergoing OPCAB were allocated into three equally-numbered groups through simple randomization: Adenosine group, ischemic group, and control group. The patients in the Adenosine group received an infusion of Adenosine. In the ischemic group, ischemic preconditioning was induced by the temporary occlusion of the left anterior descending coronary artery twice for a 2-minute period, followed by 3-minute reperfusion before bypass grafting of the first coronary vessel. The control group received an intravenous infusion of 0.9% saline. Blood samples at differen...

Myocardial dysfunction is a major complication in cardiac surgery that needs inotropic support.
This study evaluates the effect of milrinone on patients with low ventricular ejection fraction undergoing offpump
coronary artery bypass graft (OPCAB). The present study is designed to evaluate the effect of
milrinone on myocardial dysfunction. Eighty patients with low ventricular ejection fraction (<35%),
candidate for elective OPCAB, were enrolled in this study. They were randomly assigned to two groups. One
group received milrinone (50 μg/kg) intravenously and another group received a saline as placebo followed
by 24 hours infusion of each agent (0.5 μg/kg/min). Short outcome of patients such as hemodynamic
parameters and left ventricular ejection fraction were variables evaluated. Serum levels of creatine
phosphokinase, the MB isoenzyme of creatine kinase, occurrence of arrhythmias and mean duration of
mechanical ventilation were significantly lower in milrinone group (P<0.05). The mean post operative left
ventricular ejection fraction was significantly higher in milrinone group (P=0.031). There were no statistical
significant differences between the two groups in terms of intra-aortic balloon pump, inotropic support
requirement, myocardial ischemia, myocardial infarction, duration of inotropic support, duration of intensive
care unit stay, mortality and morbidity rate. Administration of milrinone in patients undergoing OPCAB with
low ventricular ejection fraction is useful and effective.

BACKGROUND:

Atrial fibrillation (AF) is the most common arrhythmia after open heart surgery that can lead to early morbidity and mortality following operation. Mitral stenosis (MS) is a structural abnormality of the mitral valve apparatus that can be resulted from previous rheumatic fever or non-rheumatic fever such as congenital mitral stenosis, malignant carcinoid disease etc. This study was designed to test the hypothesis that type of mitral stenosis can affect the incidence, duration and frequency of AF post mitral valve replacement.
MATERIALS AND METHODS:

We selected fifty patients with rheumatic mitral stenosis and 50 patients with non-rheumatic mitral stenosis who were candidates for mitral valve replacement (MVR) surgery. Pre-operative tests such as CRP, ESR, CBC, UA, ANA, APL (IgM, IgG), ANCA, RF were performed on participants' samples and the type of mitral stenosis, rheumatic or non-rheumatic, was determined clinically. Early post-operative complications such as infection, bleeding, vomiting, renal and respiratory dysfunction etc., were recorded. All patients underwent holter monitoring after being out of ICU to the time of discharge.
RESULTS:

The mean age of patients was 48.56 ± 17.64 years. 57 cases (57%) were male, and 43 cases (43%) were female. Post-operative AF occurred in 14 cases (14%); 3 cases (6%) in non-rheumatic mitral stenosis group, and 11 cases (22%) in the rheumatic mitral stenosis group. There was a significant relationship between the incidence of AF and type of mitral stenosis (P = 0.02). Renal dysfunction after MVR was higher in rheumatic MS group than in non-rheumatic MS group (P = 0.026). There was no relationship between the type of mitral stenosis (rheumatic or non-rheumatic) and early mortality after mitral valve replacement (P = 0.8).
CONCLUSION:

We concluded that the type of mitral stenosis affect post-operative outcomes, especially the incidence of atrial fibrillation and some complications after mitral valve replacement.

The Effect of Coronary Artery Bypass Graft Surgery on Blood Oxygenation Status Gholamali Mollasadeghi MD*, Mehdi Fathi MD, Reza Samadani, MD and Ali Dabbagh MD** Abstract Introduction-Cardiopulmonary bypass (CPB) in patients undergoing coronary artery bypass graft surgery (CABG) carries ...