1. KING ABDULAZIZ UNIVERSITY HOSPITAL CARDIAC SURGERY UNIT Dr. Khalid Al-Ibrahim Dr. Hussein Jabbad Dr. Khalid Medhat Dr. Ragab Shehata

2. STARTED From 28 th Feb. 2006 once weekly Till may 2006 then twice weekly

3. Total No. : 53cases Coronary artery bypass graft Coronary artery bypass graft CABG ( 35cases ) CABG ( 35cases ) -Age : 45 – 69 years -Age : 45 – 69 years Mean age : 52.5 years Mean age : 52.5 years -No of graft : 1- 5 grafts -No of graft : 1- 5 grafts Mean No. : 3.4 grafts Mean No. : 3.4 grafts

5. Valve replacement ( 15 cases ) Valve replacement ( 15 cases ) - Aortic Replacement : 2cases. - Aortic Replacement : 2cases. - Mitral Replacement : 5 cases. - Mitral Replacement : 5 cases. - Aortic+mitral : 2 case. - Aortic+mitral : 2 case. Mitral+tricuspid 2 cases Mitral+tricuspid 2 cases Mitral repair 3 cases - Combined (Valve Rep + CABG ) : One case

6. Rheumatic aortic valves Normal aortic valve

7. Different types of prosthetic valve

8. Valve replacement - Age 13 - 43 years old Mean 31.7 years Mean 31.7 years Total No. of valves 11 valves - Tissue : 5 valves - Mechanical: 6 valves - Rings : One ring for tricuspid valve repair  3 mitral

9. Other cases Ascending aortic aneurysm in a marfan Ruptured interventricular septum

10. Operative field in cardiac surgery

11. Operating room for cardiac surgery

12. Noncardiac cases Noncardiac cases : PDA surgical ligation (7). : Pacemaker insertion. : Oesophageal enteric cyst excision. : AAA repair ( 2 ). : PA banding. : Fem-Pop bypass graft.

13. PACEMAKER INSERTION IN 30 DAYS OLD INFANT

14. PRE OP. POST OP. TERATOMA EXCSTION IN 17 Y OLD GIRL

15. C-T chest of 17 ys old girl showing Teratoma

16. SVC Aneurysm  CXR of 50 years old female

17. C-T chest of the same patient

18. C-T chest of 31 y old female with enteric cyst of the esophagus

19. RESULTS One case postoperative mortality Successes rate 98 % Mortality rate 2 %

20. MORBIDITY ( 1 ) Perioperative MI:- 4 cases - ↑ cardiac enzyme & troponin 3 cases - S-T changes 4 cases - New Q wave 2 cases - New left bundle block 2 cases

21. (2) Postoperative bleeding ( Re-exploration) ( No Patients need re-exploration). ( No Patients need re-exploration). Avarage total drain : 370 ml Avarage blood given : 2 unit Avarage ffp given : 3 unit Avarage plat. Given : 2 unit

22. (3) Post operative Arrhythmia - Atrial fibrillation : 3 cases, all regained SR - Heart block : No cases - PVCs : 2 cases - Bigeminy : one case - V. T( NS ) : one case - V. F : No case

23. (4) Wound infection - Superficial wound infection in 5 cases, With frequent dressing healed within one With frequent dressing healed within one week. week. -One case of deep leg wound infection. -No cases of Deep sternal wound infection - No cases of mediastinitis

24. (5) Low cardiac output -Occurs in 3 cases:- - 2 cases Need IABP. - One case Need LVAD.

25. (6) Postoperative DVT One case P/ CABG developed DVT in unusual site, axillary & brachial veins, unusual site, axillary & brachial veins, (predisposed by central line insertion) (predisposed by central line insertion) - Readmitted to hospital and treated medically, - Improved and discharged.

26. Successful case of ascending aortic aneurysm repair  A 43 y old Indonesian man  12cm asc aortic aneurysm  Congestive heart failure  Renal and liver impairment

30. Ruptured interventricular septum  65 years male post acute anterior M.I.  Cardiogenic shock requiring I.A.B.P +Inotropes  Emergency open heart  Transventricular incision  Transventricular incision  Pericardial patch repair Teflon sheet enforced ventricular closure

31. - ICU stay : 2 – 6 days Mean 3 days - Hospital stay: 7 – 23 days Mean 11 days Mean 11 days

32. Follow up All patients are followed up regularly in out patient clinic

33. FUTURE OF CARDIAC SURGERY IN KAUH 1- Increase the OR days up to 3 days weekly 2- Plan to sit Cardiac surgery for pediatrics 3- Private cases 4-Expand cardiology 5- Haematology clinic for valve patients

34. THANK YOU