Impact of Clinical and Sociodemographic Factors on Quality of Life Following Coronary Artery Bypass Grafting: A Mixed-Methods Study.

INTRODUCTION: Coronary artery bypass grafting (CABG) is an essential surgical management modality for patients with coronary artery disease. Health-related quality of life (HRQoL) has become important because of the significant decrease in the mortality rate associated with CABG. We aimed to explore the factors that affect the quality of life after CABG. METHODS: This study used a descriptive correlational design to assess the determinants of HRQoL using the 36-item Short Form Health Survey questionnaire (SF-36). Patients who underwent CABG at King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between March 2015 and December 2021 were enrolled in this study. Overall, 275 participants were eligible for our study, of which 84 were found to be valid for analysis. Phone contacts were made directly with the patient after briefly explaining the study. Scores and clinical data were investigated using multivariable linear regression analysis. RESULTS: Subscales of role limitations due to physical issues had the lowest mean scores, followed by vitality and general health (57.4 ± 44.7; 60.4 ± 25.6; 64.1 ± 22.6), respectively. However, social functioning (78.9 ± 29.0) and pain (75.1 ± 29.9) had the highest scores of all subscales. A history of congestive heart failure (CHF) was independently associated with lower scores for physical role limitations (p = 0.021), vitality (p = 0.001), general health (p< 0.001), and mental health (p = 0.011). Lower mental health scores were also predicted by being a widow (p = 0.030), whereas lower general health scores were predicted by being unemployed (p = 0.001) and having a peripheral vascular disease (PVD) (p = 0.043). Additionally, the development of postoperative complications was an independent predictor of lower physical functioning (p = 0.028) and vitality (p = 0.043). Regarding the number of grafts, cardiopulmonary bypass, and cross-clamp time, no significant impact was found on any of the SF-36 subscales (p> 0.05). CONCLUSION: The postoperative decline in HRQoL was attributed to comorbidities such as CHF and PVD, postoperative complications including bleeding and wound infection, as well as unemployment and widowed status. Therefore, choosing the appropriate patients for surgery and post-discharge follow-up may enhance HRQoL.

Cardiac Surgery Morbidity and Mortality in Hypertensive and Arrhythmic Patients: A Retrospective Analysis.

BACKGROUND: Hypertension (HTN) is the most significant modifiable risk factor for cardiovascular disease (CVD) and overall mortality. HTN is defined as a systolic blood pressure of ≥140 mmHg and/or a diastolic blood pressure of ≥ 90 mmHg. Generally, arrhythmias are characterized by a disruption of the heart's regular rhythm. They are strongly associated with increased risks of CVDs and sudden death. The most common arrhythmia worldwide is atrial fibrillation (AF). HTN, diabetes mellitus (DM), and coronary artery disease (CAD) are major risk factors for arrhythmias. OBJECTIVE: We aimed to identify the postoperative effects and risk factors of HTN and cardiac arrhythmia in patients who underwent cardiac surgery at King Abdulaziz University Hospital (KAUH) from 2015 to 2022. METHODS: A retrospective record review was conducted by collecting data from KAUH electronic medical records. A total of 402 patients participated in this study. This study includes all hypertensive and arrhythmic patients who underwent cardiac surgeries. RESULTS: Of the 402 patients studied, 209 had pre-operative HTN, and 47 had preoperative AF. Developing post-operative arrhythmia was found to significantly increase perioperative morbidity and mortality (p < 0.001). Risk factors for HTN and arrhythmia included increased age, higher BMI, and DM. CONCLUSION: The findings of this study suggest an association between preoperative HTN and AF and elevated rates of postoperative morbidity and mortality. AF emerged as the predominant arrhythmia type. It is advisable to optimize patients' health status prior to surgical procedures. Moreover, further research is recommended in this field to deepen our understanding of the perioperative implications of HTN and arrhythmias.

The Quality of Life in Patients With Valve Prosthesis After Undergoing Surgery for Valvular Heart Diseases.

Background and objective Surgery for valvular heart disease by valve replacement procedures has become one of the most frequently performed cardiac operations to improve the quality of life (QoL). Its long-term outcomes are assessed using the quality-of-life index (QLI). This study aimed to evaluate the QoL in patients who received valve prostheses after surgery for valvular heart diseases at King Abdulaziz University in Jeddah from 2010 to 2023. Methods This was a descriptive cross-sectional study of 59 patients aged 18 years or older who underwent surgical mitral and aortic valve replacement, involving either mechanical or tissue valves, from January 2010 to May 2023 They were selected using a non-probability convenient sampling technique. Their medical records were reviewed and the participants were interviewed via phone using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, which was used to measure the QoL of patients (https://neurotoolkit.com/whoqol-bref/). Results The study found that the QoL of the participants varied across different domains. The psychological domain had the highest mean score of 79.76, while the physical domain had the lowest mean score of 61.5. The other domains, - social, environmental, and spiritual - had mean scores of 68.05, 69.9, and 73.25, respectively. There was a statistically significant association between the QoL and nationality and chronic diseases. However, the duration after surgery and the type of valve did not significantly correlate with the QoL in the different domains. Conclusion Based on our findings, heart valve replacement improves the QoL of patients. Healthcare organizations and providers should aim to improve the management of chronic diseases to optimize outcomes.

Effect of Gender on Postoperative Outcome and Duration of Ventilation After Coronary Artery Bypass Grafting (CABG).

INTRODUCTION: The study assessed coronary artery bypass grafting (CABG) postoperative outcomes and associated factors in Saudi male and female patients. This was a retrospective cohort of patients who underwent CABG at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, from January 2015 to December 2022.  Results: We included 392 patients, of whom 63 (16.1%) were female. Female undergoing CABG were significantly older (p=0.0001), had a significantly higher incidence of diabetes (p=0.0001), obesity (p=0.001), hypertension (p=0.001), and congestive heart failure (p=0.005), with a smaller body surface area (BSA) (p=0.0001) than male. Though renal dysfunction, previous cerebrovascular accident/transient ischemic attack (CVA/TIA), and myocardial infarction (MI), incidences were similar in both genders. Females were at significantly higher risk of mortality (p=0.0001), longer hospital stay (p=0.0001), and prolonged ventilation (p=0.0001). Preoperative renal dysfunction was the only statistically significant predictor of postoperative complications (p=0.0001). Female gender and preoperative renal dysfunction, were significant independent predictors of postoperative mortality and prolonged ventilation (p=0.005). CONCLUSION: This study's findings indicated that females have worse CABG outcomes and a higher risk of morbidities and complications. Uniquely our study showed a higher incidence of prolonged ventilation in females postoperatively.

Frequency and Risk Factors of Unplanned 30-Day Readmission After Open Heart Surgeries: A Retrospective Study in a Tertiary Care Center.

BACKGROUND: Unplanned 30-day readmission post-cardiac surgery imposes higher risks for complications, increased costs, and unfavorable events for the care provider and patient. This study was to determine the unplanned readmission rate, determinants, and most common events within 30 days post-cardiac surgery. Recommendations to prevent or minimize these complications are included. METHODS: Setting and design - a retrospective record review was conducted among all adult patients, who underwent open heart surgery between 2010 and 2020 at King Abdulaziz University Hospital (KAUH), Jeddah, Kingdom of Saudi Arabia. Using Google Forms, we manually collected data from hospital records. STATISTICAL ANALYSIS USED: binomial logistic regression model (using the backward stepwise method). Regression outcomes were expressed as odds ratios (ORs) and 95% CIs. A P-value of < 0.05 indicated statistical significance. RESULTS: Among 400 patients who underwent cardiac surgery, 343 patients were included in the study, including 53 unplanned readmissions, which was a rate of 16.3% (95% CI, 12.8 to 20.6%). The most frequently reported reasons for readmission were sternal wound infections (7.3%), pleural effusion (2.0%), and heart failure (1.7%). Female gender, high postoperative LDH and urea were the most important risk factors. CONCLUSION: Discharge planning, patient education, and cardiac surgery nurse home visit constitute the most important factors to minimize 30 days of unplanned readmission.

Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low rate.

BACKGROUND: Re-exploration of bleeding after cardiac surgery is associated with significant morbidity and mortality. Perioperative blood loss and rate of re-exploration are variable among centers and surgeons. OBJECTIVE: To present our experience of low rate of re-exploration based on adopting checklist for hemostasis and algorithm for management. METHODS: Retrospective analysis of medical records was conducted for 565 adult patients who underwent surgical treatment of congenital and acquired heart disease and were complicated by postoperative bleeding from Feb 2006 to May 2019. Demographics of patients, operative characteristics, perioperative risk factors, blood loss, requirements of blood transfusion, morbidity and mortality were recorded. Logistic regression was used to identify predictors of re-exploration and determinants of adverse outcome. RESULTS: Thirteen patients (1.14%) were reexplored for bleeding. An identifiable source of bleeding was found in 11 (84.6%) patients. Risk factors for re-exploration were high body mass index, high Euro SCORE, operative priority (urgent/emergent), elevated serum creatinine and low platelets count. Re-exploration was significantly associated with increased requirements of blood transfusion, adverse effects on cardiorespiratory state (low ejection fraction, increased s. lactate, and prolonged period of mechanical ventilation), longer intensive care unit stay, hospital stay, increased incidence of SWI, and higher mortality (15.4% versus 2.53% for non-reexplored patients). We managed 285 patients with severe or massive bleeding conservatively by hemostatic agents according to our protocol with no added risk of morbidity or mortality. CONCLUSION: Low rate of re-exploration for bleeding can be achieved by strict preoperative preparation, intraoperative checklist for hemostasis implemented by senior surgeons and adopting an algorithm for management.

Hybrid Coronary Revascularization: Perspective Current State After 25 Years of Start.

Hybrid coronary revascularization (HCR) represents a minimally invasive revascularization strategy in which the durability of the internal mammary artery to the left anterior descending artery graft is combined with percutaneous coronary intervention to treat remaining lesions. It first was introduced in the mid-1990s and aspired to bring together the "best of both worlds" - the excellent patency rates and survival benefits associated with the durable left internal mammary artery graft to the left anterior descending artery alongside the good patency rates of drug-eluting stents, which outlive saphenous vein grafts to non-left anterior descending vessels. Although in theory this is a very attractive revascularization strategy, several years later, only small randomized controlled trials comparing HCR with coronary artery bypass grafting has recently emerged in the medical literature, raising concerns regarding HCR's role. In the current review, we discuss HCR's rationale, the current evidence behind it, its limitations, and procedural challenges.

Cardiovascular Risk Factors in Coronary Artery Bypass Graft Patients: Comparison Between Two Periods.

Background Information showing risk factor trends in patients undergoing coronary artery bypass graft in Saudi Arabia is scarce. Thus, we aimed to compare cardiovascular risk factors among coronary artery bypass graft patients between two periods: 2012 and 2018. Methods This was a cross-sectional study based on hospital records at a tertiary center in Saudi Arabia. The medical records of 72 patients in 2012 and 111 patients in 2018 were reviewed. The study included all patients who underwent coronary artery bypass grafting for the first time. The chi-square test and independent t-test were used for statistical analysis; P-values less than 0.05 were considered statistically significant. Results The mean (SD) of the patient age was 61.21 (9.74) years in the first period and 58.01 (11.14) years in the second period. The number of patients who smoked was significantly higher in the second period of the study (14.3% in the first period; 27.0% in the second period; P < 0.001). The study also showed an increase in hypertension and diabetes mellitus in the second period compared to the first (70% vs 71.2% and 68.6% vs 72.1%, respectively), and a reduction in the percentage of patients with hypercholesterolemia (18.3% vs 17.1%). However, these findings were non-significant. Conclusions The percentage of smokers was significantly higher in the second period of this research as a consequence of cultural variation and because of the popularity of water-pipe smoking in the society. We recommend the need for increased awareness regarding smoking and the implementation of smoking-cessation programs.

Postoperative Pneumonia Following Open Heart Surgery.

Objectives This study aimed to measure the incidence and record the relations between risk factors of postoperative pneumonia (POP) among patients who underwent open heart surgery in a single hospital in Saudi Arabia.  Methods This retrospective cohort study was conducted in June 2019 at King Abdulaziz University hospital in Saudi Arabia. Data including general information, comorbidities, lab investigations, preoperative risk factors, intraoperative considerations, and postoperative elements were collected and analyzed. Results A total of 255 cardiac surgeries were performed from November 2014 to June 2019. Two hundred of the 255 cardiac surgeries were analyzed as open-heart surgeries. Only five patients were diagnosed with POP after open heart surgery with an incidence of 2.5%. The mean age of these patients was 47±18 years, more than half of them were smokers, three were hypertensive, four were classified as ASA 4, and three underwent the operation electively. The mean bypass time was 100.3 ± 24.5 min, the mean duration of operation was 199 ± 86.2 min, the mean postoperative intensive care unit (ICU) stay was 97.4 ± 83.4 hours, and the mean overall hospital stay was 10.4 ± 7.2 days. We observed significant differences in only the following correlations: amount of blood transfusion with ICU stay and with the overall hospital stay. Conclusion The incidence of developing postoperative pneumonia in patients undergoing open heart surgery in the King Abdulaziz University hospital from November 2014 to June 2019 was 2.5%, indicating a high-quality level of surgical technique and proper infection control.

Sternal Wound Complications: Objective Reclassification and Surgical Reconsideration.

Background: Sternal wound complications pose a tremendous challenge post-cardiac surgery. There's no consensus or clear guidelines to deal with them. We propose that simple and more objective classification helps to organize the range of sternal wound complications and suggest a relevant treatment strategy. Methods: One-hundred-sixteen cases of sternal wound complications retrospectively were reviewed out of 2,391 adult patients, who underwent full sternotomy during cardiac surgery from 2006 to 2018. Eighty-six cases conservatively were managed and the remaining 30 cases required surgical intervention. More objective classification was proposed and less invasive fasciocutaneous flap was considered for nearly all reconstructive procedures. Results: The incidence of sternal wound complications was 4.8%. Conservative management was adopted for 86 cases, mean duration was 11.19 ± 9.8 days. Surgical management was performed in 30 patients (25.86%); 28 (93.3%) of whom recovered with good outcomes with less invasive fasciocutaneous flap done for 13 cases. Two cases had recurrence; one conservatively was managed and other was reoperated and healed well. The most common organisms in recurrent infections were N. coagulase (29.8%), Klebsiella (12.5%), pseudomonas (10.5%), and MRSA (10.5%). We had 4 mortalities. None of the mortalities were related to sternal wound complications; one was related to the cardiac surgery. Conclusions: Sternal wound complications are grave events. Objective classification and proper management selection will gain better outcomes.

Excess nonhemorrhagic pleural drainage after surgery for congenital heart diseases: Single center experience.

OBJECTIVE: Chylothorax after surgery for congenital heart disease is an uncommon but serious complication that adversely affects surgical outcomes. The aim of our study was presenting our experience for the management of postoperative chylothorax and excess nonhemorrhagic pleural drainage. METHODS: Medical records of patients with excess nonhemorrhagic pleural drainage were retrospectively reviewed and the collected data included demographics, surgical procedures, drainage characteristics, methods of postoperative management, and outcome. RESULTS: From March 2011 to May 2018, 52 patients with excess postoperative pleural drainage were identified from a total of 816 pediatric patients operated upon for congenital cardiac disease, giving an incidence of 63.7%. Tetralogy of Fallot and single ventricle morphology were the most common cardiac pathology. The serum triglyceride level was checked and found elevated in 30 patients (53.5%). The maximum daily drainage was 136.25 ± 109.7 mL/day and the mean duration of drainage was 32.23 ± 35.7 days. Medium-chain triglyceride formula was given for 27 patients (51.9%), octreotide for 22 (42.3%) for a mean duration of 8.07 ± 28.3 days. Total parenteral nutrition was needed for 11 patients (21.1%) for a mean duration of 3.13 ± 7.63 days. The success rate for conservative management was 94.2%. Thoracic duct ligation performed for three patients. The mean duration of mechanical ventilation was 7.4 ± 3.6 days, mean intensive care unit stay was 29.6 ± 35.1 days, and mean total hospital stay was 20.9 ± 17.5 days. We had six cases of hospital mortality (11.53%). CONCLUSION: Initiation of a stepwise approach for excess nonhemorrhagic pleural drainage based on the amount and rate of drainage achieve a favorable outcomes.

Reinforced sternal closure: the bilateral straight longitudinal wire technique.

Sternal dehiscence and mediastinitis are among the most severe complications of median sternotomy. A simplified technique of reinforced closure is described. A straight wire is inserted longitudinally on each side of the sternum, placed within the transverse wires when the latter are approximated. Using this technique in 112 patients with a precarious sternum, no cases of sternal dehiscence or mediastinitis have been seen.

A unique spectrum of deep vein thrombosis and pulmonary embolism; management guidelines.

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