[Show abstract][Hide abstract] ABSTRACT: Emergency coronary artery bypass is associated with increased operative mortality. The objective of this study was to evaluate the efficiency and safety of off-pump emergency coronary artery bypass, and to compare the outcome with that of the conventional on-pump procedure. Data of 79 patients who underwent emergency isolated coronary artery bypass were reviewed retrospectively; 45 had off-pump coronary bypass and 34 had conventional surgery. In the off-pump group, mean ejection fraction was significantly lower (28% +/- 9% vs. 39% +/- 10%), and there were fewer grafts per patient (1.8 +/- 0.7 vs. 3.2 +/- 0.8). Early mortality was higher in the conventional surgery group (14.7% vs. 8.9%), but late mortality was similar in both groups. Patients who had on-pump surgery had lower rates of recurrent angina (16% vs. 34%) and symptoms of heart failure (20% vs. 51%). Re-hospitalization was more common in off-pump patients, but cardiac re-interventions were similar. There was no significant difference in 5-year survival rates. The results of off-pump coronary bypass were better than the preoperative predicted EuroSCORE, thus it was concluded that patients treated on an emergency basis should have an off-pump revascularization procedure.
Asian cardiovascular & thoracic annals 05/2009; 17(2):133-8.
[Show abstract][Hide abstract] ABSTRACT: In a cross-sectional survey conducted in 2005, we determined the prevalence metabolic syndrome (MetS) and other atherosclerotic cardiovascular disease risk factors among a sample of 342 Palestinians > or = 20 years in East Jerusalem. Participants were interviewed and anthropometric measurements and blood testing were done. MetS was found in 115 (33.6%) participants, with no significant difference between the sexes. The prevalence of obesity, diabetes and other cardiovascular risk factors was also high, with central obesity and obesity (BMI > or = 30 kg/m2) being significantly higher in women (P <0.01). With the exception of low-density lipoprotein cholesterol and haemoglobin, there was a significantly higher prevalence of atherosclerotic markers among the MetS group.
Eastern Mediterranean health journal = La revue de santé de la Méditerranée orientale = al-Majallah al-ṣiḥḥīyah li-sharq al-mutawassiṭ 01/2009; 15(6):1464-73.
[Show abstract][Hide abstract] ABSTRACT: Atherosclerosis of the internal mammary artery is a rare disease. We describe a case in which a 41-year-old man underwent coronary artery bypass surgery 23 years after repair of aortic coarctation. The diseased mammary artery was used to graft the left anterior descending coronary artery after intraoperative confirmation of good patency. Early graft occlusion occurred a few days after the operation. This case demonstrates that atherosclerosis affects mammary arteries after long-term repair of aortic coarctation. Such conduits should not be used, even in the presence of good blood flow.
The Annals of thoracic surgery 01/2009; 86(6):1991-4. · 3.45 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Priapism is a rare disorder defined as a persistent penile erection that continues hours beyond, or is unrelated to, sexual stimulation. There are two types of priapism; ischemic low-flow type or non-ischemic high flow, with differing etiologies. Priapism associated with thrombophilia is a well-recognized entity. However, the pathogenesis of this association is not fully understood. We report a rare case of recurrent (stuttering) priapism in a patient with protein C deficiency while maintained on Warfarin therapy. This therapy was also complicated by Warfarin-induced skin necrosis.
International Journal of Laboratory Hematology 09/2008; 30(4):339-43. · 1.29 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Left ventricular function is an independent predictor of operative mortality. The outcome of myocardial revascularization is greatly affected by the severity of impairment of cardiac function. The present study was undertaken to find the early and midterm mortality and morbidity among patients with different degrees of myocardial function undergoing off-pump bypass.
Hundred and forty two patients with isolated coronary revascularization were divided into three groups according to left ventricle ejection fraction (LVEF). Forty eight patients with LVEF<30% (group I), 48 patients with LVEF between 30-40% (group II), and 46 patients with LVEF >40% (group III). Clinical, operative and post operative outcome were compared. Patients were followed up to find midterm survival and control of symptoms.
The mean age for the patients observed was 56.5+/-9.8 years. Preoperative predicted mortality according to euroSCORE was much higher in group I due to high incidence of preoperative heart failure and recent myocardial infarction. The extent of coronary vessel involvement was similar among the three groups, but those in group III had more single vessel disease. The number of grafts performed per patient was lowest in group I (1.7+/-0.6) and highest in group III (2.0+/-0.6) P=0.03. Overall hospital mortality was 4.2%.The mean euroSCORE of patients who died was 18.7+/-22.5. All in-hospital mortality was among patients who belonged to the high risk group I, 6 (12.5%). Morbidity was similar among all groups. The incidence of myocardial infarction, atrial fibrillation, and acute renal failure were slightly higher in group I; 95.6% of patients were followed up for 7-69 months (mean 27.6+/-17.6). The incidence of angina in group I, II, and III was 20%, 6.5%, and 2.2%. Symptomatic heart failure was seen in 17.5% in group I, 6.5% in group II, and 2.2% in group III. Cardiac interventions among group I, II, III was 12.5%, 4.3% and 2.3% respectively. Redo coronary artery bypass CABG was higher in group II (4.3%) compared to 2.5% in group I. Late mortality was similar among all groups.
Off-pump bypass can be used safely among patients with different degrees of myocardial function. The results of surgery were better than the preoperative predicted euroSCORE. Early mortality and morbidity were directly related to ejection fraction .This is true only when LVEF is below 30%. Midterm mortality was similar among different risk groups.
The Journal of cardiovascular surgery 09/2008; 49(4):519-26. · 1.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Iatrogenic coronary artery dissection extending into the aorta is a rare condition. We report a case in a 46-year-old male patient who had dissection of the right coronary artery which occurred during diagnostic coronary catheterization. The dissection extended retrogradely to affect the right coronary sinus. The patient was treated successfully by coronary artery bypass grafting with repair of the aortic dissection.
Journal of Cardiac Surgery 01/2008; 23(2):177-9. · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Intra-coronary entrapment of angioplasty hardware is a rare complication of coronary intervention. Such complication is potentially dangerous. We present two cases of an entrapped fractured guidewire during angioplasty. They were managed by urgent coronary bypass.
Journal of Cardiac Surgery 01/2007; 22(6):526-8. · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Management of patients with severely impaired left ventricular function (LVF) associated with diffusely atheromatous coronary artery disease is a real dilemma. Coronary revascularization can be done only after endarterectomy to facilitate anastomosis. The aim of the present work is to present our experience and see whether performing endarterectomy during off-pump bypass can be of any benefit.
Five patients with a mean ejection fraction of 27 +/- 4.5 underwent coronary revascularization facilitated by endarterectomy using off-pump technique. There were three males and two females with a mean age of 64.4 +/- 7.4 years. All patients were in NYHA class III or IV. Close endarterectomy was done to left anterior descending artery (LAD), right coronary artery (RCA), and intermediate artery.
All patients survived the procedure. A total of seven closed endarterectomies were performed. Five of these were done on LAD and the other two were done on RCA and intermediate artery. Two patients (40%) received inotropic support. One patient had perioperative infarction (20%). Mean follow-up period was 14.2 months +/- 19.7 (range, 1 month to 48 months). All patients were free of angina according to Canadian Cardiovascular Society and were in class NYHA I or II except one, who was in class III. Postoperative catheterization showed that all bypasses to endarterectomized arteries were patent. Patency rate was 83.4%. The mean postoperative ejection fraction was 29.8 +/- 6.9, which was not significantly different from preoperative one (p= 0.12).
Performing endarterectomy on beating heart in patients with compromised left ventricle is not an easy task. But it can be done with difficulty. Although the procedure is associated with high incidence of infarction, our early results, follow-up clinical status, and graft patency justify its use among patients with compromised left ventricular function who were previously considered inoperable.
Journal of Cardiac Surgery 01/2007; 22(1):69-72. · 1.35 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We present a rare neglected case of fungal pulmonary valve endocarditis which presented with typical extra cardiac manifestations after repeated injections for treatment of visceral leishmaniasis. Surgical intervention to replace the pulmonary valve was the only option to manage the patient in spite of extensive medical treatment.
The Journal of infection 11/2006; 53(4):e185-9. · 4.13 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Left ventricular dysfunction is an important predictor of in-hospital mortality. Surgical risk among these patients remains high. The present study is conducted to evaluate the difference in early morbidity and mortality among patients with compromised left ventricular function (LVF) after myocardial revascularization using either off-pump or on-pump coronary artery bypass graft.
Between April 2000 and April 2004, 150 patients with ejection fraction (EF) < or =35% underwent isolated coronary artery bypass grafting. Eighty-four patients underwent conventional bypass (mean EF 30.1%+/- 4.2) and 66 patients had off-pump coronary artery bypass (mean EF 27.5%+/- 5.5). Different variables (preoperative, intraoperative, and postoperative) were evaluated and compared. Determination of operation risk was done using EuroSCORE. Patients who underwent OPCAB were more risky due to a high percentage of associated comorbidities, mean EuroSCORE was 12.96 +/- 13.21 in comparison to 8.47 +/- 10.22 in CCAB.
The mean operative mortality was 8.7%. Patients who underwent OPCAB had a lower operative mortality than CCAB (6.1% vs. 10.7%) inspite of a higher preoperative predicted risk score. Completeness of revascularization was higher among the CCAB group (85.7% vs. 69.7%; p = 0.01). Subsequently, the mean number of grafts was significantly higher among this group (3.4+/-0.7 vs. 2.0 +/-0.9; p < 0.001). On the other hand, morbidity was significantly higher in CCAB (35.7% vs. 19.7%; p = 0.03). However, the incidence of both myocardial infarction and atrial fibrillation was more among OPCAB.
Patients with left ventricular dysfunction are high-risk group. These patients can benefit from myocardial revascularization using either off-pump or conventional CABG, but both are associated with a higher mortality and morbidity than those with normal ventricle. The use of off-pump CABG resulted in better clinical outcome and mortality, but less number of grafts performed than those with conventional CABG especially in patients with lowest EF.
Journal of Cardiac Surgery 01/2006; 21(1):22-7. · 1.35 Impact Factor