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KING ABDULAZIZ UNIVERSITY HOSPITAL CARDIAC SURGERY UNIT Dr. Khalid Al-Ibrahim Dr. Khalid Medhat Dr. Hussein Jabbad Dr. Ragab Shehata STARTED th 28 From Feb. 2006 once weekly Till may 2006 then twice weekly Total No. : 53cases Coronary artery bypass graft CABG ( 35cases ) - Age : 45 – 69 years Mean age : 52.5 years - No of graft : 1- 5 grafts Mean No. : 3.4 grafts Valve replacement ( 15 cases ) - Aortic Replacement : 2cases. - Mitral Replacement : 5 cases. - Aortic+mitral : 2 case. Mitral+tricuspid 2 cases Mitral repair 3 cases - Combined (Valve Rep + CABG ) : One case Rheumatic aortic valves Normal aortic valve Different types of prosthetic valve Valve replacement - Age 13 - 43 years old Mean 31.7 years Total No. of valves 11 valves - Tissue : 5 valves - Mechanical: 6 valves - Rings : One ring for tricuspid valve repair 3 mitral Other cases Ascending aortic aneurysm in a marfan Ruptured interventricular septum Operative field in cardiac surgery Operating room for cardiac surgery Noncardiac cases : PDA surgical ligation (7). : Pacemaker insertion. : Oesophageal enteric cyst excision. : AAA repair ( 2 ). : PA banding. : Fem-Pop bypass graft . PACEMAKER INSERTION IN 30 DAYS OLD INFANT PRE OP. POST OP. TERATOMA EXCSTION IN 17 Y OLD GIRL C-T chest of 17 ys old girl showing Teratoma CXR of 50 years old female SVC Aneurysm C-T chest of the same patient C-T chest of 31 y old female with enteric cyst of the esophagus RESULTS One case postoperative mortality Successes rate 98 % Mortality rate 2% MORBIDITY ( 1 ) Perioperative MI:- 4 cases - ↑ cardiac enzyme & troponin - S-T changes - New Q wave - New left bundle block 3 cases 4 cases 2 cases 2 cases (2) Postoperative bleeding ( Re-exploration) ( No Patients need re-exploration). Avarage Avarage Avarage Avarage total drain blood given ffp given plat. Given : 370 ml : 2 unit : 3 unit : 2 unit (3) Post operative Arrhythmia - Atrial fibrillation : 3 cases, all regained SR - Heart block : No cases - PVCs : 2 cases - Bigeminy : one case - V. T( NS ) : one case - V. F : No case (4) Wound infection - Superficial wound infection in 5 cases, With frequent dressing healed within one week. - One case of deep leg wound infection. - No cases of Deep sternal wound infection - No cases of mediastinitis (5) Low cardiac output Occurs in 3 cases:- - 2 cases Need IABP. - One case Need LVAD. (6) Postoperative DVT One case P/ CABG developed DVT in unusual site, axillary & brachial veins, (predisposed by central line insertion) - Readmitted to hospital and treated medically, - Improved and discharged. Successful case of ascending aortic aneurysm repair A 43 y old Indonesian man 12cm asc aortic aneurysm Congestive heart failure Renal and liver impairment Ruptured interventricular septum 65 years male post acute anterior M.I. Cardiogenic shock requiring I.A.B.P +Inotropes Emergency open heart Transventricular incision Pericardial patch repair Teflon sheet enforced ventricular closure - ICU stay : 2 – 6 days Mean 3 days - Hospital stay: 7 – 23 days Mean 11 days Follow up All patients are followed up regularly in out patient clinic FUTURE OF CARDIAC SURGERY IN KAUH 1- Increase the OR days up to 3 days weekly 2- Plan to sit Cardiac surgery for pediatrics 3- Private cases 4-Expand cardiology 5- Haematology clinic for valve patients THANK YOU