Fast track recovery of high risk coronary bypass surgery patients.

OBJECTIVE: Fast track recovery protocols on younger, low risk patients result in shorter hospital stays and decreased costs. However, data is lacking on the impact of these protocols on high risk patients based on an objective scoring system. METHODS: In this study, a high risk cohort of patients (EuroSCORE >or=6, n=158) was compared with a low risk cohort of patients (EuroSCORE <6, n=1004) to define the safety and efficacy of fast track recovery among high risk patients. A standard perioperative data is collected prospectively for every patient. RESULTS: Time to extubation was longer in the high risk group (299+/-253 vs. 232+/-256min; P=0.003), but intensive care unit (ICU) stay (25.6+/-28.7 vs. 21.5+/-9.4h; P=ns), and postoperative length of stay (5.8+/-2.4 vs. 5.6+/-2.7 days; P=ns) was similar when compared with the low risk group. Of the high risk patients 81% were extubated within 6h, 87% were discharged from the intensive care unit within 24h, and 67% were discharged from the hospital within 5 days. Multiple regression analysis showed that any red blood cell transfusion (P=0.02), and cross clamp time >60min (P=0.03) were the predictors of delayed extubation (>or=6h) in the high risk group. The predictors of extended ICU stay were any red blood cell transfusion (P=0.0001), and peripheral vascular disease (P=0.05). Any red blood cell transfusion was the only predictor for mortality (P=0.02) and readmission to the hospital within the first 30 days (P=0.02) in this cohort of patients. CONCLUSIONS: This study confirms the safety and efficacy of fast track recovery protocol among high risk patients undergoing coronary artery bypass surgery. All patients are basically suitable for fast track recovery and the preoperative risk factors are poor predictors of prolonged ventilation, increased ICU and hospital stay. Red blood cell transfusion is associated with delayed extubation and discharge from the ICU, and increased mortality and hospital readmission rate.

A huge obstructive myxoma located in the right heart without causing any symptom.

Cardiac myxoma is unusual and mostly located in left atrium. Although it is a benign tumor of the heart, it may cause life-threatening cardiac problems like valvular obstruction, systemic or pulmonary massive embolism, infection, arrhythmia, malignance. We report a huge cardiac myxoma originated from right atrium. It was moving between right atrium and ventricle without any symptoms.

Importance of the index of myocardial performance in evaluation of left ventricular function.

UNLABELLED: The index of myocardial performance (MPI) has been used as an easily obtainable parameter that reflects both systolic and diastolic functions of the myocardium and correlates closely with invasive measurements. This study investigated the importance of MPI on assessment of left ventricular function in patients with critical coronary artery disease. METHODS: We studied 82 patients who had coronary angiography and echocardiography. Patients in Group A were without critical coronary stenosis (n = 37, 17 females, 20 males, mean age 54 +/- 11 years) and patients in Group B had critical coronary stenosis (> 70%) without previous myocardial infarction (n = 45, 18 female, 27 male, mean age 57 +/- 10 years). Using echocardiographic parameters, left ventricular isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), ejection time (ET), ratio of velocity time integrals (vti) of early and late diastolic mitral flow (E/Avti), E deceleration time (EDT), MPI [(IRT + ICT) / ET], ejection fraction (EF), and fractional shortening (FS) were calculated. During cardiac catheterization, Dp/Dt [(diastolic blood pressure - left ventricular end diastolic pressure) / ICT] was calculated. RESULTS: There were significant differences in IRT, EDT, E/Avti, and the MPI between Groups A and B (95.9 +/- 14.7 and 113.4 +/- 14.3 msec, P < 0.001; 164.5 +/- 44.8 and 186.2 +/- 33.6 msec, P < 0.05; 1.51 +/- 0.45 and 1.24 +/- 0.80 msec, P < 0.05; and 0.45 +/- 0.08 and 0.53 +/- 0.07 msec, P < 0.001, respectively), but there were no significant differences in ICT, ET, EF, FS, and Dp/Dt between the two groups. Both groups showed a close correlation between MPI and Dp/Dt (r = - 0.78 for Group A and r = - 0.82 for Group B). There were no significant differences in heart rate and systolic and diastolic blood pressure between the two groups. CONCLUSION: These data suggest that MPI may be a useful parameter and an early indicator of left ventricular dysfunction in patients with critical coronary artery disease and normal systolic function.