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  1. Article ; Online: Preoperative Anemia is Associated with Increased Intraoperative Mortality in Patients Undergoing Cardiac Surgery

    Arwa Z. Al-Riyami / Balan Baskaran / Sathiya M. Panchatcharam / Hilal Al-Sabti

    Oman Medical Journal, Vol 36, Iss 3, Pp e267-e

    2021  Volume 267

    Abstract: Objectives: We sought to investigate the incidence of preoperative anemia in cardiac surgery and its association with outcomes. Methods: A retrospective review of clinical, laboratory, and transfusion data for all patients who underwent cardiac surgery ... ...

    Abstract Objectives: We sought to investigate the incidence of preoperative anemia in cardiac surgery and its association with outcomes. Methods: A retrospective review of clinical, laboratory, and transfusion data for all patients who underwent cardiac surgery at Sultan Qaboos University Hospital between 2008 and 2014 was performed. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin levels < 13 g/dL (males) and < 12 g/dL (females). Clinical variables were compared using chi-square and independent t-test. Factors influencing preoperative mortality were analyzed using multivariate binary logistics regression. Results: A total of 599 patients (69.9% males and 30.1% females) were included in the study; 69.3% underwent coronary artery bypass surgery. Preoperative anemia was found in 76.1% of females and 26.7% of male patients. Rates of intraoperative red blood cell transfusions were higher among anemic patients (75.9% vs. 52.3%, p < 0.001). Anemic patients had a worse risk profile with higher incidence of diabetes mellitus (53.8% vs. 38.9%, p < 0.001), congestive heart failure (51.4% vs. 28.3%, p < 0.001), arrhythmia (16.5% vs. 8.6%, p =0.004), and cerebrovascular disease (10.0% vs. 4.9%, p =0.015). In addition, they had a higher risk of overall mortality (6.4% vs. 2.6%, p =0.023). Preoperative anemia remained a risk factor for intraoperative mortality after logistic regression (odds ratio = 4.08, 95% confidence interval: 1.43–11.66; p= 0.009). Conclusions: Preoperative anemia in cardiac surgery is independently associated with increased intraoperative mortality and early readmission rates post-surgery.
    Keywords retrospective studies ; blood transfusion ; anemia ; cardiac surgical procedures ; Medicine ; R
    Language English
    Publishing date 2021-05-01T00:00:00Z
    Publisher Oman Medical Specialty Board
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  2. Article ; Online: Preoperative Anemia is Associated with Increased Intraoperative Mortality in Patients Undergoing Cardiac Surgery

    Arwa Z. Al-Riyami / Balan Baskaran / Sathiya M. Panchatcharam / Hilal Al-Sabti

    Oman Medical Journal, Vol 36, Iss 3, Pp e267-e

    2021  Volume 267

    Abstract: Objectives: We sought to investigate the incidence of preoperative anemia in cardiac surgery and its association with outcomes. Methods: A retrospective review of clinical, laboratory, and transfusion data for all patients who underwent cardiac surgery ... ...

    Abstract Objectives: We sought to investigate the incidence of preoperative anemia in cardiac surgery and its association with outcomes. Methods: A retrospective review of clinical, laboratory, and transfusion data for all patients who underwent cardiac surgery at Sultan Qaboos University Hospital between 2008 and 2014 was performed. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin levels < 13 g/dL (males) and < 12 g/dL (females). Clinical variables were compared using chi-square and independent t-test. Factors influencing preoperative mortality were analyzed using multivariate binary logistics regression. Results: A total of 599 patients (69.9% males and 30.1% females) were included in the study; 69.3% underwent coronary artery bypass surgery. Preoperative anemia was found in 76.1% of females and 26.7% of male patients. Rates of intraoperative red blood cell transfusions were higher among anemic patients (75.9% vs. 52.3%, p < 0.001). Anemic patients had a worse risk profile with higher incidence of diabetes mellitus (53.8% vs. 38.9%, p < 0.001), congestive heart failure (51.4% vs. 28.3%, p < 0.001), arrhythmia (16.5% vs. 8.6%, p =0.004), and cerebrovascular disease (10.0% vs. 4.9%, p =0.015). In addition, they had a higher risk of overall mortality (6.4% vs. 2.6%, p =0.023). Preoperative anemia remained a risk factor for intraoperative mortality after logistic regression (odds ratio = 4.08, 95% confidence interval: 1.43–11.66; p= 0.009). Conclusions: Preoperative anemia in cardiac surgery is independently associated with increased intraoperative mortality and early readmission rates post-surgery.
    Keywords retrospective studies ; blood transfusion ; anemia ; cardiac surgical procedures ; Medicine ; R
    Language English
    Publishing date 2021-05-01T00:00:00Z
    Publisher Oman Medical Specialty Board
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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    Inter-library loan at ZB MED

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  3. Article ; Online: Impact of Blood Transfusion on Troponin I Levels and Outcomes after Cardiac Surgery

    Arwa Z. Al-Riyami / Murtadha Al-Khabori / Balan Baskaran / Hatim Al-Lawati / Mirdavron Mukaddirov / Hilal A. Al-Sabti

    Oman Medical Journal, Vol 34, Iss 1, Pp 14-

    A Cohort Study

    2019  Volume 19

    Abstract: Objectives: Increased cardiac troponin I (TI) has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective ... ...

    Abstract Objectives: Increased cardiac troponin I (TI) has been suggested to be a sensitive indicator of intraoperative myocardial injury. We investigated the association of transfusion on TI levels post-surgery and outcomes in patients undergoing elective cardiac surgeries. Methods: We conducted a retrospective review of 542 patients. Patients were divided into two groups based on TI levels at 24 hours (TI24) (> 6.5 µg/L vs. ≤ 6.5 µg/L). The impact of transfusion on TI levels was estimated using logistic regression and adjusted for using a multivariable model that included aortic cross-clamp time and preoperative ejection fraction. The effect of TI on the clinical outcomes was examined. Results: Red blood cell (RBC) transfusion was found to be associated with high TI levels (odds ratio (OR) = 2.33, p = 0.007, 95% confidence interval (CI): 1.30–4.30). A trend was observed when aortic cross-clamp time and preoperative ejection fraction were adjusted for (OR = 2.06, p = 0.080, 95% CI: 0.90–4.70). An association was found between aortic cross-clamp time and high TI levels in the multivariable model (OR = 1.01, p = 0.028, 95% CI: 1.00–1.02). Elevated TI levels was associated with higher mortality (OR = 4.15, p = 0.017, 95% CI: 1.29–13.08), renal failure (OR = 2.99, p = 0.004, 95% CI: 1.41–6.32), and increased length of stay in-hospital (OR = 4.50, p = 0.020, 95% CI: 0.69–8.30). Conclusions: RBC transfusion is associated with increased TI24 post-cardiac surgery and worse outcomes, albeit a confounding effect cannot be excluded. Larger studies are required to confirm these findings.
    Keywords Blood Transfusion ; Troponin ; Cardiac Surgery ; Medicine ; R
    Subject code 610 ; 616
    Language English
    Publishing date 2019-01-01T00:00:00Z
    Publisher Oman Medical Specialty Board
    Document type Article ; Online
    Database BASE - Bielefeld Academic Search Engine (life sciences selection)

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  4. Article ; Online: Factors associated with prolonged length of stay following cardiac surgery in a major referral hospital in Oman: a retrospective observational study.

    Almashrafi, Ahmed / Alsabti, Hilal / Mukaddirov, Mirdavron / Balan, Baskaran / Aylin, Paul

    BMJ open

    2016  Volume 6, Issue 6, Page(s) e010764

    Abstract: Objectives: Two objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac ... ...

    Abstract Objectives: Two objectives were set for this study. The first was to identify factors influencing prolonged postoperative length of stay (LOS) following cardiac surgery. The second was to devise a predictive model for prolonged LOS in the cardiac intensive care unit (CICU) based on preoperative factors available at admission and to compare it against two existing cardiac stratification systems.
    Design: Observational retrospective study.
    Settings: A tertiary hospital in Oman.
    Participants: All adult patients who underwent cardiac surgery at a major referral hospital in Oman between 2009 and 2013.
    Results: 30.5% of the patients had prolonged LOS (≥11 days) after surgery, while 17% experienced prolonged ICU LOS (≥5 days). Factors that were identified to prolong CICU LOS were non-elective surgery, current congestive heart failure (CHF), renal failure, combined coronary artery bypass graft (CABG) and valve surgery, and other non-isolated valve or CABG surgery. Patients were divided into three groups based on their scores. The probabilities of prolonged CICU LOS were 11%, 26% and 28% for group 1, 2 and 3, respectively. The predictive model had an area under the curve of 0.75. Factors associated with prolonged overall postoperative LOS included the body mass index, the type of surgery, cardiopulmonary bypass machine use, packed red blood cells use, non-elective surgery and number of complications. The latter was the most important determinant of postoperative LOS.
    Conclusions: Patient management can be tailored for individual patient based on their treatments and personal attributes to optimise resource allocation. Moreover, a simple predictive score system to enable identification of patients at risk of prolonged CICU stay can be developed using data that are routinely collected by most hospitals.
    MeSH term(s) Aged ; Cardiac Surgical Procedures/adverse effects ; Cardiac Surgical Procedures/classification ; Cardiopulmonary Bypass ; Female ; Humans ; Intensive Care Units ; Length of Stay/statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Oman ; Postoperative Complications/epidemiology ; Postoperative Period ; Referral and Consultation ; Retrospective Studies ; Risk Factors
    Language English
    Publishing date 2016-06-08
    Publishing country England
    Document type Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 2747269-3
    ISSN 2044-6055 ; 2044-6055 ; 2053-3624
    ISSN (online) 2044-6055
    ISSN 2044-6055 ; 2053-3624
    DOI 10.1136/bmjopen-2015-010764
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Coronary artery bypass grafting in a patient with protein S deficiency: perioperative implications.

    Balan, Baskaran / Chengode, Suresh / Al Sabti, Hilal / Rao, Ram Narayan

    Annals of cardiac anaesthesia

    2014  Volume 17, Issue 3, Page(s) 232–236

    Abstract: Protein S (PS) along with activated protein C plays an important role in the down-regulation of in vivo thrombin generation. Its deficiency can cause abnormal and inappropriate clot formation within the circulation necessitating chronic anticoagulation ... ...

    Abstract Protein S (PS) along with activated protein C plays an important role in the down-regulation of in vivo thrombin generation. Its deficiency can cause abnormal and inappropriate clot formation within the circulation necessitating chronic anticoagulation therapy. The risk of developing thrombotic complications is heightened in the perioperative period in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Heparin resistance is very rare in these patients, especially when antithrombin levels are near normal. Management of CPB in this scenario is quite challenging. We report the perioperative management, particularly the CPB management, of a patient with type I PS deficiency and incidentally detected heparin resistance, who underwent coronary artery bypass grafting with CPB.
    MeSH term(s) Anticoagulants/therapeutic use ; Blood Transfusion ; Cardiopulmonary Bypass/methods ; Coronary Artery Bypass ; Heparin/therapeutic use ; Humans ; Male ; Middle Aged ; Perioperative Period/methods ; Protein S Deficiency/complications
    Chemical Substances Anticoagulants ; Heparin (9005-49-6)
    Language English
    Publishing date 2014-07
    Publishing country India
    Document type Case Reports ; Journal Article
    ZDB-ID 2106866-5
    ISSN 0974-5181 ; 0971-9784
    ISSN (online) 0974-5181
    ISSN 0971-9784
    DOI 10.4103/0971-9784.135875
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: "Open" approach to aortic arch aneurysm repair.

    Al Kindi, Adil H / Al Kimyani, Nasser / Alameddine, Tarek / Al Abri, Qasim / Balan, Baskaran / Al Sabti, Hilal

    Journal of the Saudi Heart Association

    2014  Volume 26, Issue 3, Page(s) 152–161

    Abstract: Aortic arch aneurysm is a relatively rare entity in cardiac surgery. Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task. The need to produce a relatively bloodless surgical field with ... ...

    Abstract Aortic arch aneurysm is a relatively rare entity in cardiac surgery. Repair of such aneurysms, either in isolation or combined with other cardiac procedures, remains a challenging task. The need to produce a relatively bloodless surgical field with circulatory arrest, while at the same time protecting the brain, is the hallmark of this challenge. However, a clear understanding of the topic allows a better and less morbid approach to such a complex surgery. Literature has shown the advantage of selective cerebral perfusion techniques in comparison with only circulatory arrest. Ability to perfuse the brain has allowed circulatory arrest temperatures at moderate hypothermia without the need for deep hypothermia. Even though cannulation site selection appears to be a minor issue, literature has shown that the subclavian/axillary route has the best outcomes and that femoral cannulation should only be reserved for no access patients. Although different techniques for arch anastomosis have been described, we routinely perform the distal first technique as we find it to be less cumbersome and easiest to reproduce. In this review our aim is to outline a systematic approach to aortic arch surgery. Starting with indications for intervention and proceeding with approaches on site of cannulation, approaches to brain protection with hypothermia and selective cerebral perfusion and finally surgical steps in performing the distal and arch vessels anastomosis.
    Language English
    Publishing date 2014-03-14
    Publishing country Saudi Arabia
    Document type Journal Article ; Review
    ZDB-ID 2515647-0
    ISSN 1016-7315
    ISSN 1016-7315
    DOI 10.1016/j.jsha.2014.02.006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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