Saudi Heart Association/National Heart Center/Saudi Arabian Cardiac Interventional Society/Saudi Society for Cardiac Surgeons/Saudi Cardiac Imaging Group 2023 TAVI Guidelines.

Saudi Arabia has seen a significant improvement in its healthcare system over the past four decades resulting in an increase in life-expectancy. Transcatheter aortic valve implantation (TAVI) has spread widely in Saudi Arabia and has become a routine procedure in many centers. The expanding clinical indications and the availability of the technology have made it possible for many large and intermediate centers all over the country to commence their own TAVI programs.

Should routine pulmonary function tests be performed in patients with left ventricular dysfunction and/or congestive heart failure undergoing cardiac surgery?

Background: It is controversial whether pulmonary function testing should be performed routinely in cardiac surgery patients. The aim of our study was to focus on patients who have congestive heart failure, caused by left ventricular dysfunction or left-sided heart valve disease, and study the prognostic value of performing preoperative pulmonary function testing on their postoperative outcomes.

Methods: This is a retrospective propensity score matched study that included 366 patients with congestive heart failure who underwent cardiac surgery and had preoperative pulmonary function test.

Does preoperative screening with computed tomography of the chest decrease risk of stroke in patients undergoing coronary artery bypass grafting.

Background: Stroke is one of the most feared complications post coronary artery bypass with aortic calcifications being the commonest source of embolic stroke. The aim of our study was to determine the clinical impact and usefulness of routine use of plain chest computerised tomography to screen for aortic calcification on incidence of postoperative stroke in coronary artery bypass grafting (CABG) patients.

Methods: This is a retrospective case-control study that included four hundred and five patients who underwent primary isolated CABG and had preoperative plain chest computerised tomography as a screening for aortic calcification.

Hybrid Thoracic Aortic Repair and Aortic Valve-In-Valve Replacement for Chronic Type A Dissection.

We describe a case of hybrid total thoracic aortic repair and valve-in-valve transcatheter aortic valve replacement in a high-risk patient with complicated chronic type A dissection and severe prosthetic aortic stenosis. The patient underwent a three-stage-procedure including aortic arch debranching, thoracic endovascular aortic repair of the ascending aorta, aortic arch and descending thoracic aorta, and direct aortic valve-in-valve replacement using transcatheter heart valve. The details of the procedures are described with a discussion of the challenges and the decision-making process.

Results of Surgical Ablation for Atrial Fibrillation in Patients with Rheumatic Heart Disease.

Background: There is conflicting evidence regarding the success of the Maze procedure to restore sinus rhythm in patients with rheumatic heart disease. Hence, the aim of our study was to describe the results of surgical ablation for atrial fibrillation in patients with rheumatic heart disease undergoing cardiac surgery.

Methods: This is a retrospective study that included adult patients with rheumatic heart disease who underwent surgical ablation for atrial fibrillation.

Mechanical Tricuspid Valves Have Higher Rate of Reintervention: A Single Center Experience.

Purpose: We compared the composite outcome of tricuspid valve (TV) reintervention or heart failure (HF) admission in patients who underwent tricuspid valve replacement (TVR) with tissue vs. mechanical valves.

Patients And Methods: The study included 159 patients who underwent TVR from 2009 to 2019.

Budget impact analysis of a bioprosthetic valve with a novel tissue versus mechanical aortic valve replacement in patients older than 65 years with aortic stenosis in Saudi Arabia.

Aims: A budget impact analysis (BIA) comparing bioprosthetic valves with RESILIA tissue and mechanical valves in aortic stenosis (AS) patients > 65 years in the public and private sectors of Saudi Arabia.

Materials And Methods: A decision-tree with a partitioned survival model was adapted to estimate the financial consequences of either a RESILIA tissue valve or a mechanical valve in aortic valve replacement (AVR) procedures up to 5 years. The budget impact of resource consumption for both valve types was compared and included disabling strokes, reoperations, minor thromboembolic events, major bleeding, endocarditis, anticoagulation treatment and monitoring, and echocardiogram assessments.

Serum level of prophylactic antibiotics in cardiac surgery and its implication on surgical site infection (SSI).

Background: Surgical site infection in cardiac surgery is still common despite applying preoperative antibiotic prophylaxis as per guidelines. Therefore, the aim of our study was to assess the relationship between perioperative antibiotics serum levels and the incidence of surgical site infection.

Methods: This is a prospective study that included all adult patients who underwent elective coronary artery bypass grafting between June and December 2018.

Using tissue mitral valves in younger patients: A word of caution.

Background: The debate about the optimal mitral valve prosthesis continues. We aimed to compare the early and late outcomes, including stroke, bleeding, survival, and reoperation after isolated mitral valve replacement (MVR) using tissue versus mechanical valves.

Methods: This retrospective cohort study included 291 patients who had isolated MVR from 2005 to 2015.

Paramedic Ability in Interpreting Electrocardiogram with ST-segment Elevation Myocardial Infarction (STEMI) in Saudi Arabia.

Objective: To evaluate paramedic ability in recognizing 12-lead Electrocardiogram (ECG) with ST-segment Elevation myocardial infarction (STEMI) in Saudi Arabia.

Methods: This is a quantitative exploratory cross-sectional study using an electronic survey of paramedics was conducted between June and September 2021. The survey included demographics, educational and clinical experiences, and multiple 12-lead ECG strip questions to assess participants' ability to recognize STEMI.

Ischemic cardiomyopathy versus non-ischemic cardiomyopathy in diabetic patients: clinical characteristics, management, and long-term outcomes.

Background: Diabetes mellitus causes ischemic heart disease (IHD) through macrovascular or microvascular involvement. Diabetes-associated hypertension, dyslipidemia, and obesity further increase coronary artery disease risk and can cause left ventricular hypertrophy leading to heart failure with preserved ejection fraction independent of IHD. This study was undertaken to evaluate the differences in demographics, clinical characteristics, Echocardiographic parameters, management, and outcomes between non-ischemic cardiomyopathy (NICM) and ischemic cardiomyopathy (ICM) patients in cohort of diabetes patients.

Penetrating chest injury afflicting coronary artery fistula-A delayed and asymptomatic occurrence.

We present here a case of a symptomatic chest injury with a nail gun causing a delayed occurrence of coronary artery fistula to the left pulmonary artery presenting with unstable angina 4 years after the initial injury, three of which were symptom-free. The patient underwent successful surgical closure of the fistula and removal of the foreign body.

The effect of using the minimized cardio-pulmonary bypass Systems for Coronary Artery Bypass Grafting in diabetic patients.

Introduction: Multiple studies have shown a decrease in the inflammatory response with minimized bypass circuits leading to less complications and mortality rate. On the other hand, some other studies showed that there is no difference in post-operative outcomes. So, the aim of this study is to investigate the clinical benefits of using the Minimized cardiopulmonary Bypass system in Coronary Artery Bypass Grafting and its effect on postoperative morbidity and mortality in diabetic patients as one of the high-risk groups that may benefit from these systems.

Early Hemodynamic Profile after Aortic Valve Replacement - A Comparison between Three Mechanical Valves.

Introduction: There are scarce data comparing different mechanical valves in the aortic position. The objective of this study was to compare the early hemodynamic changes after aortic valve replacement between ATS, Bicarbon, and On-X mechanical valves.

Methods: We included 99 patients who underwent aortic valve replacement with mechanical valves between 2017 and 2019.

Degree of right ventricular dysfunction dictates outcomes after tricuspid valve repair concomitant with left-side valve surgery.

Objectives: The effect of different degrees of right ventricular (RV) dysfunction on long-term outcomes after tricuspid valve repair is the subject of ongoing research. We sought to evaluate the effect of preoperative RV dysfunction on mortality and recurrence of tricuspid regurgitation (TR) after tricuspid valve repair for secondary TR concomitant with left-side valve surgery.

Methods: This is a retrospective study, including 548 patients who underwent repair of secondary TR (2009-2017) at a single institution.

Saudi Society for Cardiac Surgeons consensus document on COVID-19, April 1, 2020.

The COVID-19 pandemic represents an international health crisis that is challenging to all governments. Health practitioners in different fields have a duty to guide people and governments to achieve safe health practices. The Saudi Society for Cardiac Surgeons recognizes that it is difficult to establish evidence-based guidelines for safe cardiac surgery practices in such a crisis because this is an unprecedented health pandemic.

Surgical mitral valve replacement using direct implantation of Sapien 3 valve in a patients with severe mitral annular calcification without adjunctive techniques, a case report.

Background: Mitral annular calcification (MAC) occurs represents a challenge to surgeons during mitral valve (MV) surgery with increased perioperative risk.

Case Presentation: We describe a challenging case of an elderly female patient with multiple comorbidities who presented with symptoms and signs of heart failure with a previous history of mechanical aortic valve replacement 15 years prior to presentation. Echocardiogram showed severe mitral stenosis and regurgitation with severe calcification of the mitral annulus.

Population Pharmacokinetic Model for Vancomycin Used in Open Heart Surgery: Model-Based Evaluation of Standard Dosing Regimens.

The purpose of this study was to investigate the population pharmacokinetics of vancomycin in patients undergoing open heart surgery. In this observational pharmacokinetic study, multiple blood samples were drawn over a 48-h period of intravenous vancomycin in patients who were undergoing open heart surgery. Blood samples were analyzed using an Architect i4000SR immunoassay analyzer.

Population Pharmacokinetic Model-Based Evaluation of Standard Dosing Regimens for Cefuroxime Used in Coronary Artery Bypass Graft Surgery with Cardiopulmonary Bypass.

The purpose of this study was to investigate the population pharmacokinetics (PK) of cefuroxime in patients undergoing coronary artery bypass graft (CABG) surgery. In this observational pharmacokinetic study, multiple blood samples were collected over a 48-h interval of intravenous cefuroxime administration. The samples were analyzed by using a validated high-performance liquid chromatography (HPLC) method.

Outcomes of a Less-Invasive Approach for Proximal Aortic Operations.

Background: Less-invasive techniques have previously been described for mitral and aortic valve operations; however, few studies have examined their benefit for aortic root and ascending aorta reconstruction. Using propensity matching, we compared outcomes of patients undergoing proximal aortic operations through a J incision compared with full sternotomy.

Methods: From January 1995 to January 2014, 8,533 patients underwent proximal aortic operations at Cleveland Clinic.

Assessment of Image Quality of Repeated Limited Transthoracic Echocardiography After Cardiac Surgery.

Objectives: The use of limited transthoracic echocardiography (TTE) has been restricted in patients after cardiac surgery due to reported poor image quality. The authors hypothesized that the hemodynamic state could be evaluated in a high proportion of patients at repeated intervals after cardiac surgery.

Design: Prospective observational study.

Thrombocytopenia associated with Perceval sutureless aortic valve replacement in elderly patients: a word of caution.

Objective: The aim of this study was to report for the first time the phenomenon of thrombocytopenia associated with the use of sutureless aortic valve replacements (AVR), and try to find an explanation for its occurrence.

Methods: The data was collected retrospectively for all patients who had sutureless AVR (7 patients) and was compared to patients who underwent sutured AVR (22 patients) by the same surgeon between February 2012 and November 2013. 

Results: Cardiopulmonary bypass and cross-clamp durations were shorter in the sutureless group (96.

Bentall procedure for an adult patient with supravalvular aortic stenosis and coronary aneurysms.

We describe the surgical management of a 35-year-old male with multiple coronary aneurysms and a diffuse form of supravalvular aortic stenosis who presented with acute myocardial infarction and left ventricular dysfunction. The patient underwent a Bentall procedure with left internal mammary artery to left anterior descending artery bypass grafting with the use of cardiopulmonary bypass utilizing the right axillary artery for arterial cannulation.