MORBIDITY & MORTALITY�CARDIOTHORACIC SURGERY DEPARTMENT��1/ 9/ 2019 TO 29/ 9 / 2019� �BY/ KHADIGA FATHY

CLASSIFICATION OF CASES

• Adult cardiac 5 cases
• Congenital cardiac 1 cases
• Thoracic 2 cases
• Vascular 12 cases
• Emergency and trauma 20 cases

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Total number of cases 40 cases

ADULT CARDIAC�

Total 5 cases

• MVR →→→→→→→→→→→ 1 case
• DVR →→→→→→→→→→→ 2 case
• CABG →→→→→→→→→→ 1 case
• AVR →→→→→→→→→→→ 0 case
• Redo MVR →→→→→→→→ 1 case

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CONGENITAL � �

Total 1 cases

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• PDA →→ →→ → 1 case

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THORACIC

• Total 2 cases
• Thoracic surgery 1 cases

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- Chest wall mass 1 cases

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• Bronchoscopy(FB) 1 cases

VASCULAR

Total 12 cases

- 10 cases A-V shunt for renal dialysis

- 2 case Porta cath

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EMERGENCY AND TRAUMA

• Total 20cases

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• Emergency thoracotomy 0 cases

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• Tube thoracostomy Trauma 12 cases

Medical 8 cases

COMPLICATIONS

EXPLORATION

1 Case

• Hanan Mohammed,DVR,TVrep, prof.Dr/Ibrahim Kasab, Dr/ M Foaad, for bleeding, medical oozing and bleeding from under surface of sternum and strab muscle.

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ARRHYTHMIAS

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• 1 case needed cardioversion

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Emad Mosaad,CABG( pre-op. sinus rhythm )

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Developed at first hour at ICU VT and DC two times and returned-sinus and given cordaron

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PULMONARY COMPLICATIONS

1 Cases was re-intubated and ventilated

• Karima El-Syed, prof.Dr. yosry El-Saeed.

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Patient was tachypnic after weaning from vent and reintubated and was feverish from first day and developed septicemia and died 3 days later.

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LOW CARDIAC OUTPUT

2 cases

Cases required Inotropes : 3 cases

• Imad mosad ibrahim , CABG,prof.Dr/Ibrahim,after closing wirePT entered at VT and reopened another graft done to RT coronary and high adrenalin ,levo support added ↓.
• Karema , redo mitral, dr/ yosry el said pt was vasoplegic with low cvp levophed 160, adrenaline 100,

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Cases required IABP : 1 case

• Imad mosad Ibrahim,CABG, 2g,prof.Dr/Ibrahim Kasb, ↓ Bl, 🡩CVP ↓ urine, initial improvement then deteriorated

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WOUND INFECTION

• 1 case

Superficial wound infection

• Soad Abd EL Hamid , MVR,, Dr/ Moataz , 2ry stitches and improved

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Mortality

3/4 (75%) of Open Ht ,

3 Cases

• 1- Imad mosad , 55y, CABG 2g LIMA⇨LAD, SVG⇨OM, by Dr/Ibrahim Kasb on

preoperative Echo was OK with EF above 50 in the OR weaning smoothly from CPB, contractility was ok suddenly after wire closure PT developped VT and arrested opened and entered on bypass another vein graft done to distal RT coronary that was atherosclerotic with significant lesion LIMA

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was pulsating another vein graft done distal to it levo support elevated to 300 at Icu pt developed VT DC shock done and cordaron added blood pressure was border line on high support IAB inserted on second day and adrenalin elevated to 200 and levo was 250 there was initial improvement but deterioration continued and pt was haemodynamically unstable and PT died after 4 days.

MORTALITY

• 2-karema stuck mitral valve mean gradient was 33 preoperative echo show EF 50 and CXR show some sort of congestion PT was pregnant and entered at pressure border line 90/50 at operation room PT replaced mitral valve and weaned smoothly from bypass at ICU PT

developped high grade fever TLC was high around 25 pt was tachypnic after trial of weaning from vent and reventilated again at third day pt became haemodnamically unstable levo support elevated fever not subsiding blood and urine culture taken pt was at septic shock and died third day after surgery.

• 3 -Hanan triple valve echo before operation show sever pulmonary HT and fair contractility PT HCV positive and platlets was 160 the day befor surgry pt developped pulmonary oedema and ventilated and was on small dose levo pt entered OR valve replacement done with no significant event on OR at ICU PT drainage after 4 hours post operation was around 900 cm blood and drain was blocked despite suction HB was 9 then became 6 pt reexplored there

• was bleeding from under surface of sternum and around strab muscle and support elevated 3 hours later at icu drainage of tubes continued at rate 200/h pt reexplorated at icu there was oozing and clots with no significant point PT was open chest and bleeding did not stop despite fresh blood platlets and cryo and urine output decreased second day post operation pt arrested

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Thank you