KING ABDULAZIZ UNIVERSITYKING ABDULAZIZ UNIVERSITY

HOSPITAL HOSPITAL CARDIAC SURGERY UNITCARDIAC SURGERY UNIT

Dr. Khalid Al-Ibrahim Dr. Hussein JabbadDr. Khalid Al-Ibrahim Dr. Hussein JabbadDr. Khalid Medhat Dr. Ragab ShehataDr. Khalid Medhat Dr. Ragab Shehata

STARTED STARTED

From 28From 28thth Feb. 2006 Feb. 2006 once weekly once weekly

Till may 2006 then Till may 2006 then twice weeklytwice weekly

Total No. : 53casesTotal No. : 53cases Coronary artery bypass graftCoronary artery bypass graft

CABG ( 35cases CABG ( 35cases )) - Age : 45 – 69 yearsAge : 45 – 69 years

Mean age : 52.5 yearsMean age : 52.5 years

- No of graft : 1- 5 graftsNo of graft : 1- 5 grafts

Mean No. : 3.4 graftsMean No. : 3.4 grafts

Valve replacementValve replacement ( ( 15 cases )15 cases )

- - Aortic Replacement : 2casesAortic Replacement : 2cases..

- - Mitral Replacement : 5 casesMitral Replacement : 5 cases..

- - Aortic+mitral : 2 caseAortic+mitral : 2 case..

Mitral+tricuspid 2 casesMitral+tricuspid 2 cases

Mitral repair 3 casesMitral repair 3 cases

- Combined (Valve Rep + CABG ) : One case- Combined (Valve Rep + CABG ) : One case

Rheumatic aortic valves Normal aortic valveRheumatic aortic valves Normal aortic valve

Different types of prosthetic valveDifferent types of prosthetic valve

Valve replacementValve replacement

- -Age 13 - 43 years oldAge 13 - 43 years old

Mean 31.7 yearsMean 31.7 years

Total No. of valves 11 valvesTotal No. of valves 11 valves

- Tissue : 5 valves - Tissue : 5 valves

- Mechanical: 6 valves- Mechanical: 6 valves

- Rings : One ring for tricuspid valve repair- Rings : One ring for tricuspid valve repair 33 mitralmitral

Other casesOther cases

Ascending aortic aneurysm in a Ascending aortic aneurysm in a marfan marfan

Ruptured interventricular septum Ruptured interventricular septum

Operative field in cardiac surgeryOperative field in cardiac surgery

Operating room for cardiac surgeryOperating room for cardiac surgery

Noncardiac casesNoncardiac cases

: PDA surgical ligation (7).: PDA surgical ligation (7).

: Pacemaker insertion.: Pacemaker insertion.

: Oesophageal enteric cyst excision. : Oesophageal enteric cyst excision.

: AAA repair ( 2 ).: AAA repair ( 2 ).

: PA banding.: PA banding.

: Fem-Pop bypass graft .: Fem-Pop bypass graft .

PACEMAKER INSERTION IN 30 DAYS OLD INFANTPACEMAKER INSERTION IN 30 DAYS OLD INFANT

PRE OP. POST OP.PRE OP. POST OP.

TERATOMA EXCSTION IN 17 Y OLD GIRLTERATOMA EXCSTION IN 17 Y OLD GIRL

C-T chest of 17 ys old girl showing TeratomaC-T chest of 17 ys old girl showing Teratoma

SVC AneurysmSVC Aneurysm

CXR of 50 years old femaleCXR of 50 years old female

C-T chest of the same patientC-T chest of the same patient

C-T chest of 31 y old female with enteric C-T chest of 31 y old female with enteric cyst of the esophaguscyst of the esophagus

RESULTSRESULTS

One case postoperative mortalityOne case postoperative mortality

Successes rate 98Successes rate 98% %

Mortality rate 2Mortality rate 2% %

MORBIDITYMORBIDITY

) )11 ( ( Perioperative MIPerioperative MI:- 4 cases:- 4 cases

- -↑↑ cardiac enzyme & troponin 3 casescardiac enzyme & troponin 3 cases

- -S-T changes 4 casesS-T changes 4 cases

- -New Q wave 2 casesNew Q wave 2 cases

- -New left bundle block 2 casesNew left bundle block 2 cases

))22 ( (Postoperative bleedingPostoperative bleeding( Re-exploration)( Re-exploration)

) ) No Patients need re-explorationNo Patients need re-exploration.).)

Avarage total drain : 370 mlAvarage total drain : 370 ml

Avarage blood given : 2 unitAvarage blood given : 2 unit

Avarage ffp given : 3 unitAvarage ffp given : 3 unit

Avarage plat. Given : 2 unitAvarage plat. Given : 2 unit

))33 ( (Post operative ArrhythmiaPost operative Arrhythmia

- -Atrial fibrillation : 3 cases, all regained SRAtrial fibrillation : 3 cases, all regained SR

- -Heart block : No casesHeart block : No cases

- -PVCs : 2 casesPVCs : 2 cases

- -Bigeminy : one caseBigeminy : one case

- -V. T) NS ) : one caseV. T) NS ) : one case

- -V. F : No caseV. F : No case

))44 ( (Wound infectionWound infection

- -Superficial wound infection in 5 casesSuperficial wound infection in 5 cases,,

With frequent dressing healed within oneWith frequent dressing healed within one

weekweek..

- One case of deep leg wound infection.One case of deep leg wound infection.

- No cases of Deep sternal wound infectionNo cases of Deep sternal wound infection

- -No cases of mediastinitisNo cases of mediastinitis

))55 ( (Low cardiac outputLow cardiac output

-Occurs in 3 casesOccurs in 3 cases-:-:

- -22 cases Need IABPcases Need IABP..

- -One case Need LVADOne case Need LVAD..

))66 ( (Postoperative DVTPostoperative DVT

One case P/ CABG developed DVT inOne case P/ CABG developed DVT in

unusual site, axillary & brachial veinsunusual site, axillary & brachial veins , ,

) ) predisposed by central line insertionpredisposed by central line insertion ) )

- -Readmitted to hospital and treated medicallyReadmitted to hospital and treated medically,,

- -Improved and dischargedImproved and discharged..

Successful case of ascending aortic Successful case of ascending aortic aneurysm repairaneurysm repair

A 43 y old Indonesian manA 43 y old Indonesian man 12cm asc aortic aneurysm12cm asc aortic aneurysm Congestive heart failureCongestive heart failure Renal and liver impairmentRenal and liver impairment

Ruptured interventricular septumRuptured interventricular septum

6565 years male post acute anterior M.Iyears male post acute anterior M.I.. Cardiogenic shock requiring I.A.B.P Cardiogenic shock requiring I.A.B.P

+Inotropes+Inotropes

Emergency open heartEmergency open heart Transventricular incisionTransventricular incision

Pericardial patch repair Pericardial patch repair

Teflon sheet enforced ventricular Teflon sheet enforced ventricular closureclosure

- ICU stay : 2 – 6 daysICU stay : 2 – 6 days Mean 3 days Mean 3 days

- Hospital stay: 7 – 23 days- Hospital stay: 7 – 23 days

Mean 11 daysMean 11 days

Follow upFollow up

All patients are followed up regularly in out All patients are followed up regularly in out patient clinicpatient clinic

FUTURE OF CARDIAC SURGERY FUTURE OF CARDIAC SURGERY IN KAUH IN KAUH

11 - -Increase the OR days up to 3 days weeklyIncrease the OR days up to 3 days weekly

22 - -Plan to sit Cardiac surgery for pediatricsPlan to sit Cardiac surgery for pediatrics

33 - -Private casesPrivate cases

44--Expand cardiologyExpand cardiology

55 - -Haematology clinic for valve patientsHaematology clinic for valve patients

THANK YOUTHANK YOU