Cost and clinical effectiveness of aggressive surgical debridement and delayed primary closure of infected cardiac surgical wounds.

Objective: Postoperative wound infection in cardiac surgery remains a subject of significant concern due to associated morbidity, prolonged hospital stay and rise in treatment cost. A conservative management approach to postoperative wound infection with topical dressings and healing by secondary intention is not cost-effective and cosmetic results are less acceptable. We developed our institutional protocol for the treatment of infected postoperative cardiac surgical wounds to reduce hospital stay and improve cosmetic outcome.

Extracorporeal membrane oxygenation in adults: experience from the Middle East.

Background: The literature reports conflicting results for survival after extracorporeal membrane oxygenator support, and survival differs in pediatric and adult patients. We present our institutional experience of adult extracorporeal membrane oxygenator support.

Methods: From January 2007 to December 2009, 19 adult patients required extracorporeal membrane oxygenator support after cardiac surgery or catheter interventions.

A high-volume heart transplantation center in an Islamic country.

Cardiac transplants are performed sporadically or not at all in the majority of predominantly Muslim countries in the Middle East. We examined our experience in 76 patients who underwent heart transplantation between January 2005 and May 2010 in our center in Saudi Arabia. Excluded were 50 transplants performed between 1989 and 2004, due to incomplete data.

Hybrid management strategy for percutaneous Fontan completion without surgery: early results.

Background: We report early results of surgical preparation and subsequent percutaneous Fontan completion strategy for the treatment of single-ventricle defects.

Methods: Two hundred twenty-seven patients underwent bidirectional cavopulmonary connection (BDCPC) between 2002 and 2007. Thirty-four patients had lateral tunnel created at time of BDCPC, fenestrated with 10 to 14 mm openings with the cardiac superior vena cava end patched to maintain BDCPC physiology.

Predictive value of intraoperative in situ radial artery conduit flow assessment prior to harvesting during coronary artery bypass surgery.

Objective: Radial artery (RA) is increasingly preferred as the second best conduit in coronary artery bypass grafting (CABG). Harvesting techniques affect the integrity of the RA with implications for the immediate and late outcome. The aim of this study was to describe a simple intra-operative technique that allows the quality of the RA to be assessed prior to its harvesting during CABG.

Determinants of short- and long-term outcomes following triple valve surgery.

Background And Aim Of The Study: Triple valve surgery (3VS) is required in some cardiac disorders that simultaneously involve the aortic valve (AV), mitral valve (MV), and tricuspid valve (TCV). Herein are reported details of the authors' experience with 3VS, and their attempts to identify those factors associated with a poor clinical outcome.

Methods: The medical records of patients who underwent 3VS between 1985 and 2005 were reviewed.

Simultaneous aortic and mitral valve replacement in children: time-related outcomes and risk factors.

Background And Aim Of The Study: Valve replacement in children is problematic, and associated with high anticoagulation-related complications and increased reoperation requirements. Multiple valve replacement may further increase morbidity and worsen outcome. The results are reported of combined aortic valve replacement (AVR) and mitral valve replacement (MVR) in children.

Superior results following the Ross procedure in patients with congenital heart disease.

Background And Aim Of The Study: The Ross procedure is a versatile operation that can be applied for aortic valve replacement (AVR) in patients with congenital heart disease (CHD), including small infants and those with complex left ventricular outflow tract (LVOT) obstruction. Herein, the clinical outcome is reported following the Ross procedure in patients with CHD at the authors' institution.

Methods: The medical records of patients who underwent the Ross procedure for CHD between 1991 and 2007 were reviewed.

Silent meningioma - a rare cause of stroke in post-cardiopulmonary bypass patients.

Stroke in cardiac patients undergoing surgery is usually attributed to the use of cardiopulmonary bypass. In this report, we present an unusual cause of cerebral dysfunction: a meningioma leading to stroke, following coronary artery bypass grafting in a 62-year-old patient. Diagnosis and treatment options of the pathology are discussed with the guidance of the literature.

The Ross procedure in children: preoperative haemodynamic manifestation has significant effect on late autograft re-operation.

Objectives: The Ross procedure is the aortic valve-replacement procedure of choice in children. Nonetheless, late autograft re-operation for dilatation and/or valve regurgitation is of concern. We examined whether preoperative haemodynamic manifestation (e.

Intermediate results following complex biventricular repair of left ventricular outflow tract obstruction in neonates and infants.

Objectives: Although the majority of infants with severe left ventricular outflow tract obstruction (LVOTO) can be managed with balloon or surgical aortic valvotomy, a more complex biventricular repair may be required in a subset of infants with multi-level obstruction, failure of or complication to prior intervention. In the presence of normal left ventricle size and inflow, the Ross procedure is applied in patients with/without ventricular septal defect (VSD), while the Yasui procedure is applied only in those with VSD. We report mid-term outcomes in a single institution.

Results after mitral valve replacement with mechanical prostheses in young children.

Objective: We examined outcomes after mitral valve replacement in children younger than 8 years.

Methods: Medical records of patients who underwent mitral valve replacement from 1990 to 2006 were reviewed. Competing-risks methodology determined time-related prevalence and associated factors for death, repeated valve replacement, and survival without reoperation.

Open heart surgery in patients with sickle cell hemoglobinopathy.

Background: In patients with sickle cell trait or disease, reduced life expectancy and a tendency for complications are believed to negatively affect likelihood of survival after open heart surgery. The aim of this study was to review retrospectively the perioperative results of patients undergoing cardiac surgery at our institution.

Methods And Results: Between January 1995 and December 2006, 47 patients with either sickle cell disease or sickle cell trait underwent open heart surgery at our institution.

The rastelli procedure for transposition of the great arteries: resection of the infundibular septum diminishes recurrent left ventricular outflow tract obstruction risk.

Background: The Rastelli procedure is the standard surgical treatment of d-transposition of great arteries (d-TGA), ventricular septal defect (VSD), and pulmonary stenosis. Late morbidity is significant due to recurrent left ventricular outflow obstruction (LVOTO), early conduit obstruction, and arrhythmias, with troublesome late mortality. To avoid recurrent LVOTO, we routinely enlarge the VSD and resect the infundibular septum before LV baffling to the aorta.

Results of left atrioventricular valve reoperations following previous repair of atrioventricular septal defects.

Objectives: We report results of left atrioventricular valve reoperations (LAVVR) following atrioventricular septal defect (AVSD) repair and examine variables predictive of outcome.

Methods: Multiple demographics and operative variables were analyzed to determine factors affecting survival and reoperation.

Results: Forty patients following partial (n = 9) or complete (n = 31) AVSD repair underwent 47 LAVVR (1992-2005).

The prevalence, clinical characteristics, and prognosis of diastolic heart failure: a clinical study in elderly Saudi patients with up to 5 years follow-up.

Data from 519 patients older than 65 years with congestive heart failure (CHF) were analyzed after 5 years of clinical follow-up. Two groups were included in the analysis: 321 patients with ejection fractions > or =50% (group with diastolic heart failure) and 198 patients with reduced ejection fraction <50% (group with systolic heart failure). Hypertension (81%) was the strongest predictor of congestive heart failure, followed by diabetes (46%) and coronary disease (33%).

Aortic and mitral valve replacement in children: is there any role for biologic and bioprosthetic substitutes?

Objective: The ideal valve substitute in children does not exist. Biologic and bioprosthetic valves do not require anticoagulation, however their use is complicated by accelerated degeneration and requirement for reoperation. We examine results following mitral (MVR) or aortic (AVR) replacement with biologic and bioprosthetic valves at our institution.

Long-term (up to 18 years) clinical and echocardiographic results of mitral balloon valvuloplasty in 531 consecutive patients and predictors of outcome.

Objectives: The study aim was to assess the long-term results (up to 18 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival.

Methods: The immediate and long-term results for 531 consecutive patients (mean age 31 +/- 11 years) who underwent successful MBV and were followed up for a mean of 8.5 +/- 4.

Mechanical valves versus the Ross procedure for aortic valve replacement in children: propensity-adjusted comparison of long-term outcomes.

Objective: We aimed to identify characteristics differentiating children undergoing aortic valve replacement by using mechanical prostheses versus the Ross procedure and to compare survival and the need for aortic valve reoperation after each procedure.

Methods: From 1983 to 2004, 346 children underwent aortic valve replacement (215 underwent the Ross procedure and 131 underwent placement of a mechanical prosthesis). Factors associated with procedure choice were used to construct a propensity score for use as a covariate in regression models to adjust for potential confounding by indication.

Immediate and long-term results of mitral balloon valvuloplasty in patients with severe pulmonary hypertension.

Background And Aim Of The Study: Mitral stenosis (MS) with severe pulmonary hypertension (PHT) constitutes a high-risk subset for surgical commissurotomy or valve replacement. Mitral balloon valvuloplasty (MBV) has emerged as the treatment of choice for patients with severe pliable MS. The efficacy of this procedure in patients with severe PHT has not been fully elucidated, notably with regards to the long-term outcome.

Surgical strategy to establish a dual-coronary system for the management of anomalous left coronary artery origin from the pulmonary artery.

Background: Optimal repair of anomalous origin of left coronary artery from pulmonary artery (ALCAPA) relies on the creation of a dual-coronary system. If the anomalous coronary arises at a long distance from the aorta, we use various coronary extension techniques to facilitate tension-free implantation.

Methods: Thirty patients underwent ALCAPA operations using direct coronary transfer (n = 11) or coronary extension techniques (n = 19).

Impact of atrial fibrillation on immediate and long-term results of mitral balloon valvuloplasty in 531 consecutive patients.

Background And Aim Of The Study: Conflicting evidence exists regarding the impact of atrial fibrillation (AF) on the immediate and long-term outcome of mitral balloon valvuloplasty (MBV). The study aim was to investigate such outcome in 531 consecutive patients.

Methods: The immediate and long-term (up to 18 years) clinical and echocardiographic results of MBV of 71 patients with AF at baseline were prospectively collected and compared with those of 460 patients in normal sinus rhythm (NSR).