- Email: [email protected]
72. Value of postoperative hyperglycemia for outcome of coronary artery bypass grafting surgery
326
ABSTRACTS
ABSTRACTS
to higher mortality in patients with pulmonary hypertension. Conclusions: Pulmonary hypertension clearly affects early and late survival after MV surgery. Better survival and shorter duration of hospital stay in patients without PH supports early admission for MV surgery before occurrence of PH. http://dx.doi:10.1016/j.jsha.2015.05.250
70. Surgical mitral valve replacement with modified Melody valve in children Ahmed Badr Elwy, N. Albahlooli, H. Hamid, Y. Al Fariedi, K. AlKhalaf, A. Al Sahari, A. Al Otay, K. Al Najashi, R.M. Di Donato Objective: We describe a case of mitral valve (MV) replacement using modified Melody valve implantation. Methods: A 2.5 year-old girl,with a history of ALCAPA repair in April 2012, had undergone MV repair by ring annuloplasty at 1 year of age. She came back with severe MV stenosis (mean gradient, 8 mmHg) and regurgitation. She had a hugely dilated left atrium and a MV annulus of 14 mm. She, then, underwent surgical MV replacement with a modified Melody valve. Results: The Melody valve was prepared before the cardiopulmonary bypass. The procedure included stent shortening and adding a bovine pericardial sewing ring. Through a trans-septal approach, the previous MV ring was removed, the pericardial ring patch of the Melody valve was secured to the mitral annulus and the ventricular end of the valve was fixed to the posterior–inferior wall of the left ventricle. The prosthesis was then inflated to size 16 mm. Testing of the valve showed good leaflet coaptation. The atrial septum was closed by fenestrated (4 mm) bovine pericardial patch. TEE showed good valve function with a tiny paravalvular leak and no left ventricular outflow obstruction. The pulmonary veins were also unobstructed. Conclusions: The modified Melody valve is a viable option for children MV annular diameters, providing a valid alternative to existing prostheses. The technique is relatively easy and the short term result is very good. This prosthesis will be particularly attractive if maintaining competence after subsequent dilations as the child grows. http://dx.doi:10.1016/j.jsha.2015.05.251
71. Incidence of paravalvular leakage after aortic and mitral valve replacement at KFSH & RS, single centre experience Nedim Selimovic (Faisal Harthy), Abd-Alkareem Al-Allaf, Vaqas Ahmed
J Saudi Heart Assoc 2015;27:299–330
Background: Paravalvular leakage (PVL) is not rare and can be a serious clinical problem in 1–5% of all valve replacement. There are inconclusive data regarding the incidence of PVR after aortic valve replacement (AVR) and mitral valve replacement (MVR).The aim of this study was to review PVL based upon more than ten years experience from King Faisal Specialist Hospital & Research Centre. Method: Retrospective analysis of the consecutive adult patients that underwent surgical valve replacement between January 2000 and December 2011. Results: During the period of 12 years (January 2000 through December 2011), prosthetic valve replacement surgery was performed in 2060 patients, aortic valve replacement (AVR) in 655, mitral valve replacement (MVR) in 1048 and combined AVR and MVR in 357 patients. From echocardiography database we found significantly higher incidence of PVL after combine AVR + MVR (n = 48; 13.45% than isolated MVR (n = 46; 4.38%) and AVR (n = 29; 4.43%). Mechanical valve was implanted in 82 cases and bioprosthesis in 41 cases. Initial VR was performed in 55% of patients (n = 68). First re-do has been done in 32 patients (26%), second-, third- and forth reoperation were performed in 11 (8.9%), 9 (7.3%) and 3 (2.4%) patients, respectively. Mild to moderate PVL was diagnosed in 90 cases (73%) and 33 (27%) patients had moderate to severe PVR according TTE. It was significantly higher percentage of moderate and severe PVR after MVR than AVR (p = 0.025). There was significantly higher incidence of reoperation in mitral then aortic position (p = 0.037). Conclusion: Paravalvular leakage after mitral valve replacement is severe and has a more detrimental clinical outcome compared to that after aortic valve replacement. Incidence of PVL is significantly higher after combine valve replacement than single valve replacement. http://dx.doi:10.1016/j.jsha.2015.05.252
72. Value of postoperative hyperglycemia for outcome of coronary artery bypass grafting surgery Mohamed Abdulwahab Alassal Objectives: To determine the frequency of postoperative (PO) hyperglycemia in non-diabetic patients underwent Coronary artery bypass grafting (CABG) surgery and to evaluate its predictability for the outcome of these patients. Patients & Methods: The study included all patients assigned for CABG surgery and had no previous history of diabetes mellitus with preoperative fasting blood glucose of <110 mg/dl. Hyperglycemia was diagnosed if random blood glucose (RBG) levels are >180 mg/dl. Patients were categorized according RBG into: Normoglycemics had RBG <180 mg/dl and Hyperglycemics had RBG <180 mg/dl. Intraoperative data included frequency of CABG with beating heart and number of internal mammary artery graft used, aortic artery clamping, CPB and
total operative times. Postoperative data included the frequency of hyperglycemic patients, occurrence of PO morbidities and mortality. All hyperglycemic patients received insulin infusion adjusted to achieve RBG level of 126–179 mg/dl. Results: All patients had significantly higher postoperative RBG levels compared to preoperative levels. Fortythree patients were hyperglycemic, while 57 patients were considered normoglycemic. Throughout ICU and hospital stay, 31 patients developed morbidities and 4 patients died with significantly higher frequency of additional morbidities and mortalities in hyperglycemic versus normoglycemic patients. There was positive significant correlation between the frequency of PO morbidities and mortality and extent of PO hyperglycemia, aortic clamping, CPB and total operative times. ROC curve and regression analyses showed that the extent of PO hyperglycemia, aortic clamping, CPB and total operative times are the significant predictors for morbidities and mortalities. Conclusion: PO hyperglycemia showed deleterious effects on outcome of CABG patients manifested as increased frequency of morbidities and mortalities during ICU and hospital stay and the extent of hyperglycemia could be considered as independent predictor of worsened outcome. The applied management policy allowed reduction of blood glucose levels without inducing hypoglycemia with subsequent improved outcome. http://dx.doi:10.1016/j.jsha.2015.05.253
73. Custodiol versus blood cardioplegia in pediatric cardiac surgery Ebtehal Qulaissi, Osman Al-Radi, Rajab Debes Introduction: Cardioplegia is a solution used to arrest and protect the heart during open cardiac repair with the use of cardiopulmonary-bypass. Two types of cardioplegia were evaluated. Blood cardioplegia and HTK crystalloid cardioplegia known as Custodiol. Objectives: To evaluate the efficacy of myocardial protection with antegrade intermittent oxygenated blood cardioplegia in comparison to a single dose of Custodiol in pediatric cardiac surgery. Methods: A retrospective cohort study was performed between November 1st, 2013 and June 30th, 2014. Fiftytwo patients underwent congenital heart procedure at King Abdul-Aziz University Hospital with the use of cardiopulmonary-bypass and cardioplegia. Forty-two received blood cardioplegia and ten received Custodiol. Data were collected from operative reports, electronic and paper charts. Statistical analysis was done using Pearsontest for continuous data and Kruskal–Wallis-test for categorical data. P-Value of 0.05 was considered significant. Results: Patients in the Custodiol group experienced longer duration of cardiopulmonary-bypass time (median value of 84 versus 77.5 min), aortic clamping time (63 versus 50.5 min) and total operation time (175 versus 144 min), compared to the Blood group. The duration of
ABSTRACTS
327
mechanical ventilation was longer in the Custodial group, 72 versus 48 h in the Blood group (p = 0.016). The incidence of post-operative arrhythmia requiring treatment was also higher in Custodiol group, 50% versus 12% in the Blood group (p = 0.02). Low output syndrome, acute kidney injury and death were not statistically significantly different between two groups. Conclusions: Custodiol may have inferior myocardial protection compared to blood cardioplegia in children undergoing cardiac surgery. A randomized comparison is warranted. http://dx.doi:10.1016/j.jsha.2015.05.254
74. Bone density in heart transplanted patients in Kingdom of Saudi Arabia Nedim Selimovic, Asmi Nisar, Jehad Alburaiki, Feras Khaliel Background: Osteopenia and osteoporosis are prevalent in heart transplant candidates. Early, rapid bone loss is a well documented complication of steroid administration after heart transplantation. Purpose of our study was to determine incidence of osteopenia and osteoporosis in heart transplant candidates and heart transplanted patients and association with demographics characteristics, vitamin D deficiency, renal and thyroid function and long-term use of corticosteroids and immunosuppressive drugs. Methods: This is a non-randomized, retrospective, observational study. Medical files of all consecutive heart transplanted patients since the beginning of 2009 until August 2013 were reviewed. Results: Pre-transplant bone mineral density data (BMD) were available in 63 heart transplant recipients; 54 and 32, respectively, also had 1- and 2-years post-transplant BMD data. Pre-transplant lumbar spine (LS) osteopenia or osteoporosis was 35% and 8% compared with 30% and 3% in femoral neck (FN). We found significant decrease in pre-transplant BMD compared with BMD data 1 year after heart transplantation in LS (1.034 ± 0.17 vs.0.994 ± 0.13; p < 0.001) and FN (0.951 ± 0.15 vs. 0.879 ± 0.139; p < 0.001), respectively. There were no significant changes in BMD after 2 years compared with data with 1 year BMD in LS (p = 0.98) and FN (p = 0.11), respectively. BMD in LS and FN were significantly lower in female (0.92 ± 0.157 vs. 1.06 ± 0.163, p = 0.009 and 0.869 ± 0.11 vs. 0.985 ± 0.147, p = 0.017) despite younger age (26 ± 10 vs. 39 ± 13 year, p < 0.001). Vitamin D deficiency is highly representative in the Saudi population (69% of recipients have severe deficiency, level < 25 nmol/L). One year after transplantation 94% of patients are on Vitamin D3 supplement and 91% on Calcium supplement. Despite reduction of severe VITD deficiency to only 8.6% we have significant progress of osteopenia and osteoporosis 1 year after HTx. We have registered 100% use of corticosteroids 1 year after HTx.
ABSTRACTS
J Saudi Heart Assoc 2015;27:299–330
ABSTRACTS
ABSTRACTS
to higher mortality in patients with pulmonary hypertension. Conclusions: Pulmonary hypertension clearly affects early and late survival after MV surgery. Better survival and shorter duration of hospital stay in patients without PH supports early admission for MV surgery before occurrence of PH. http://dx.doi:10.1016/j.jsha.2015.05.250
70. Surgical mitral valve replacement with modified Melody valve in children Ahmed Badr Elwy, N. Albahlooli, H. Hamid, Y. Al Fariedi, K. AlKhalaf, A. Al Sahari, A. Al Otay, K. Al Najashi, R.M. Di Donato Objective: We describe a case of mitral valve (MV) replacement using modified Melody valve implantation. Methods: A 2.5 year-old girl,with a history of ALCAPA repair in April 2012, had undergone MV repair by ring annuloplasty at 1 year of age. She came back with severe MV stenosis (mean gradient, 8 mmHg) and regurgitation. She had a hugely dilated left atrium and a MV annulus of 14 mm. She, then, underwent surgical MV replacement with a modified Melody valve. Results: The Melody valve was prepared before the cardiopulmonary bypass. The procedure included stent shortening and adding a bovine pericardial sewing ring. Through a trans-septal approach, the previous MV ring was removed, the pericardial ring patch of the Melody valve was secured to the mitral annulus and the ventricular end of the valve was fixed to the posterior–inferior wall of the left ventricle. The prosthesis was then inflated to size 16 mm. Testing of the valve showed good leaflet coaptation. The atrial septum was closed by fenestrated (4 mm) bovine pericardial patch. TEE showed good valve function with a tiny paravalvular leak and no left ventricular outflow obstruction. The pulmonary veins were also unobstructed. Conclusions: The modified Melody valve is a viable option for children MV annular diameters, providing a valid alternative to existing prostheses. The technique is relatively easy and the short term result is very good. This prosthesis will be particularly attractive if maintaining competence after subsequent dilations as the child grows. http://dx.doi:10.1016/j.jsha.2015.05.251
71. Incidence of paravalvular leakage after aortic and mitral valve replacement at KFSH & RS, single centre experience Nedim Selimovic (Faisal Harthy), Abd-Alkareem Al-Allaf, Vaqas Ahmed
J Saudi Heart Assoc 2015;27:299–330
Background: Paravalvular leakage (PVL) is not rare and can be a serious clinical problem in 1–5% of all valve replacement. There are inconclusive data regarding the incidence of PVR after aortic valve replacement (AVR) and mitral valve replacement (MVR).The aim of this study was to review PVL based upon more than ten years experience from King Faisal Specialist Hospital & Research Centre. Method: Retrospective analysis of the consecutive adult patients that underwent surgical valve replacement between January 2000 and December 2011. Results: During the period of 12 years (January 2000 through December 2011), prosthetic valve replacement surgery was performed in 2060 patients, aortic valve replacement (AVR) in 655, mitral valve replacement (MVR) in 1048 and combined AVR and MVR in 357 patients. From echocardiography database we found significantly higher incidence of PVL after combine AVR + MVR (n = 48; 13.45% than isolated MVR (n = 46; 4.38%) and AVR (n = 29; 4.43%). Mechanical valve was implanted in 82 cases and bioprosthesis in 41 cases. Initial VR was performed in 55% of patients (n = 68). First re-do has been done in 32 patients (26%), second-, third- and forth reoperation were performed in 11 (8.9%), 9 (7.3%) and 3 (2.4%) patients, respectively. Mild to moderate PVL was diagnosed in 90 cases (73%) and 33 (27%) patients had moderate to severe PVR according TTE. It was significantly higher percentage of moderate and severe PVR after MVR than AVR (p = 0.025). There was significantly higher incidence of reoperation in mitral then aortic position (p = 0.037). Conclusion: Paravalvular leakage after mitral valve replacement is severe and has a more detrimental clinical outcome compared to that after aortic valve replacement. Incidence of PVL is significantly higher after combine valve replacement than single valve replacement. http://dx.doi:10.1016/j.jsha.2015.05.252
72. Value of postoperative hyperglycemia for outcome of coronary artery bypass grafting surgery Mohamed Abdulwahab Alassal Objectives: To determine the frequency of postoperative (PO) hyperglycemia in non-diabetic patients underwent Coronary artery bypass grafting (CABG) surgery and to evaluate its predictability for the outcome of these patients. Patients & Methods: The study included all patients assigned for CABG surgery and had no previous history of diabetes mellitus with preoperative fasting blood glucose of <110 mg/dl. Hyperglycemia was diagnosed if random blood glucose (RBG) levels are >180 mg/dl. Patients were categorized according RBG into: Normoglycemics had RBG <180 mg/dl and Hyperglycemics had RBG <180 mg/dl. Intraoperative data included frequency of CABG with beating heart and number of internal mammary artery graft used, aortic artery clamping, CPB and
total operative times. Postoperative data included the frequency of hyperglycemic patients, occurrence of PO morbidities and mortality. All hyperglycemic patients received insulin infusion adjusted to achieve RBG level of 126–179 mg/dl. Results: All patients had significantly higher postoperative RBG levels compared to preoperative levels. Fortythree patients were hyperglycemic, while 57 patients were considered normoglycemic. Throughout ICU and hospital stay, 31 patients developed morbidities and 4 patients died with significantly higher frequency of additional morbidities and mortalities in hyperglycemic versus normoglycemic patients. There was positive significant correlation between the frequency of PO morbidities and mortality and extent of PO hyperglycemia, aortic clamping, CPB and total operative times. ROC curve and regression analyses showed that the extent of PO hyperglycemia, aortic clamping, CPB and total operative times are the significant predictors for morbidities and mortalities. Conclusion: PO hyperglycemia showed deleterious effects on outcome of CABG patients manifested as increased frequency of morbidities and mortalities during ICU and hospital stay and the extent of hyperglycemia could be considered as independent predictor of worsened outcome. The applied management policy allowed reduction of blood glucose levels without inducing hypoglycemia with subsequent improved outcome. http://dx.doi:10.1016/j.jsha.2015.05.253
73. Custodiol versus blood cardioplegia in pediatric cardiac surgery Ebtehal Qulaissi, Osman Al-Radi, Rajab Debes Introduction: Cardioplegia is a solution used to arrest and protect the heart during open cardiac repair with the use of cardiopulmonary-bypass. Two types of cardioplegia were evaluated. Blood cardioplegia and HTK crystalloid cardioplegia known as Custodiol. Objectives: To evaluate the efficacy of myocardial protection with antegrade intermittent oxygenated blood cardioplegia in comparison to a single dose of Custodiol in pediatric cardiac surgery. Methods: A retrospective cohort study was performed between November 1st, 2013 and June 30th, 2014. Fiftytwo patients underwent congenital heart procedure at King Abdul-Aziz University Hospital with the use of cardiopulmonary-bypass and cardioplegia. Forty-two received blood cardioplegia and ten received Custodiol. Data were collected from operative reports, electronic and paper charts. Statistical analysis was done using Pearsontest for continuous data and Kruskal–Wallis-test for categorical data. P-Value of 0.05 was considered significant. Results: Patients in the Custodiol group experienced longer duration of cardiopulmonary-bypass time (median value of 84 versus 77.5 min), aortic clamping time (63 versus 50.5 min) and total operation time (175 versus 144 min), compared to the Blood group. The duration of
ABSTRACTS
327
mechanical ventilation was longer in the Custodial group, 72 versus 48 h in the Blood group (p = 0.016). The incidence of post-operative arrhythmia requiring treatment was also higher in Custodiol group, 50% versus 12% in the Blood group (p = 0.02). Low output syndrome, acute kidney injury and death were not statistically significantly different between two groups. Conclusions: Custodiol may have inferior myocardial protection compared to blood cardioplegia in children undergoing cardiac surgery. A randomized comparison is warranted. http://dx.doi:10.1016/j.jsha.2015.05.254
74. Bone density in heart transplanted patients in Kingdom of Saudi Arabia Nedim Selimovic, Asmi Nisar, Jehad Alburaiki, Feras Khaliel Background: Osteopenia and osteoporosis are prevalent in heart transplant candidates. Early, rapid bone loss is a well documented complication of steroid administration after heart transplantation. Purpose of our study was to determine incidence of osteopenia and osteoporosis in heart transplant candidates and heart transplanted patients and association with demographics characteristics, vitamin D deficiency, renal and thyroid function and long-term use of corticosteroids and immunosuppressive drugs. Methods: This is a non-randomized, retrospective, observational study. Medical files of all consecutive heart transplanted patients since the beginning of 2009 until August 2013 were reviewed. Results: Pre-transplant bone mineral density data (BMD) were available in 63 heart transplant recipients; 54 and 32, respectively, also had 1- and 2-years post-transplant BMD data. Pre-transplant lumbar spine (LS) osteopenia or osteoporosis was 35% and 8% compared with 30% and 3% in femoral neck (FN). We found significant decrease in pre-transplant BMD compared with BMD data 1 year after heart transplantation in LS (1.034 ± 0.17 vs.0.994 ± 0.13; p < 0.001) and FN (0.951 ± 0.15 vs. 0.879 ± 0.139; p < 0.001), respectively. There were no significant changes in BMD after 2 years compared with data with 1 year BMD in LS (p = 0.98) and FN (p = 0.11), respectively. BMD in LS and FN were significantly lower in female (0.92 ± 0.157 vs. 1.06 ± 0.163, p = 0.009 and 0.869 ± 0.11 vs. 0.985 ± 0.147, p = 0.017) despite younger age (26 ± 10 vs. 39 ± 13 year, p < 0.001). Vitamin D deficiency is highly representative in the Saudi population (69% of recipients have severe deficiency, level < 25 nmol/L). One year after transplantation 94% of patients are on Vitamin D3 supplement and 91% on Calcium supplement. Despite reduction of severe VITD deficiency to only 8.6% we have significant progress of osteopenia and osteoporosis 1 year after HTx. We have registered 100% use of corticosteroids 1 year after HTx.
ABSTRACTS
J Saudi Heart Assoc 2015;27:299–330