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Background and purpose: Cardiovascular diseases is the leading cause of death in the world. Over the last decades, open heart surgery reduced the mortality rate of these patients. The long saphenous vein is most commonly-used conduit in coronary artery bypass surgery. Complications associated with its harvest can lead to significant patient morbidity. We aimed to determine the optimal method of wound closure in these patients by comparing single-layer with multi-layer wound closure techniques.
Materials and methods: In a randomized controlled trial, eighty patients undergoing first-time elective coronary artery bypass were randomly divided into single-layer and multi-layer leg wound closure groups. In the first group, single-layer wound cloture technique, and in the second group, multiple-layer cloture technique was applied. Postoperative complications in both groups were analyzed using SPSS software (17) and descriptive statistical tests t-test and chi-square.
Results: The two groups were comparable in respect of age, weight, height, sex and BMI. There was a significantly higher incidence of haematoma formation in the multi-layer closure group (n=18) compared with the single-layer closure group (n=5) (p<0.001). There was also a significantly higher incidence of saphenous nerve neuralgia in the multi-layer closure group on the 14th postoperative day. The incidence of postoperative pain and wound infection was also lower in the single-layer wound closure group.
Conclusion: Single-layer leg wound closure following saphenous vein harvest for coronary artery bypass grafting is associated with fewer postoperative complications and does not impair postoperative wound-healing. We recommend its routine use in this clinical setting to prevent unwanted side effects such as wound infection and / or chronic pain and hematoma formation.

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Background and purpose: Following coronary artery bypass grafting (CABG) respiratory failure is inevitable, therefore, invasive ventilation is used in patients. This study was conducted to investigate the effect of airway pressure release ventilation (APRV) on arterial blood gas (ABG) of patients after CABG.

Materials and methods: This study was conducted in 32 patients in Mashhad Imam Reza Hospital, 2014. The patients were randomly divided into two groups (n= 16 per group). The two groups received synchronized intermittent mandatory ventilation (SIMV). Then the patients in group I were switched to APRV while in group II SIMV continued for another half an hour. Afterwards, group I received SIMV and group II received APRV for half an hour. In all three stages the values for ABG were recorded. Data was then analyzed in SPSS.

Results: The mean values of PaCO₂ showed no significant changes in three stages between the two groups (P>0.05) but the mean values of PaO₂ in APRV stage in first group (P< 0.001 and P< 0.01) and second group (P< 0.003 and P< 0.002) showed significant increases compared to that of the first and second SIMV mode.

Conclusion: APRV led to improvement of oxygenation.

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Background and purpose: Sternal Wound Infection (SWI) is a serious complication of median sternotomy that increases the rate of mortality. We report our experience of managing SWI in a regional cardiothoracic unit in Mazandaran province, Iran.

Materials and methods: We prospectively studied 4725 patients who underwent isolated coronary artery bypass grafting between March 2012 and March 2015. Information about age, sex, morbidities, surgical factors and nature of sternal wound infection were recorded. Treatment options were stratified by nature of infection, and timing and nature of management. Data analysis was done using Med calc soft ware and p-values less than 0.5 were considered significant.

Results: Sternal wound infection occurred in 49 (1%) patients. There were 26 (0.55%) superficial and 23 (0.48%) deep SWIs. SWI patients were found to be mainly females, with diabetes or hypertension, high body mass indices and longer aortic cross-clamp time. All patients with superficial SWI were managed by skin debridement and closure. Patients with deep SWI who had surgery within 48 hours of diagnosis were managed using skin and bone debridement and sternal rewiring following mediastinal drain. The mortality rate was found to be high in patients with SWI (12.2%).

Conclusion: Low sternal wound infection can be achieved with an ongoing focus on appropriate infection control. SWI significantly increases the risk of mortality which could be reduced through early intervention.

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Background and purpose: There is little information about the prognostic role of preoperative serum albumin levels in postoperative outcomes following coronary artery bypass grafting (CABG). The aim of this study was to evaluate preoperative hypoalbuminemia as a predictor for complications after CABG.
Materials and methods: This prospective observational study was conducted in 200 patients undergoing CABG in Ahvaz Golestan Hospital, 2020. The patients were classified into two groups based on pre-operative hypoalbuminemia (serum Alb <3.5 g/dL). The association between hypoalbuminemia and clinical characteristics and outcomes including postoperative complications, ventilator duration, and length of hospital stay was assessed.
Results: Preoperative hypoalbuminemia was observed in 38 (19%) patients. Patients with hypoalbuminemia had higher postoperative complications including hemorrhage, infection, cardiac arrest, AKI, and in-hospital mortality than patients with normal albumin levels (84.2% vs. 13%, P<0.0001). Ventilator duration, length of hospital stay and ICU were significantly longer in hypoalbuminemia patients than normal albumin group (P<0.0001). Preoperative hypoalbuminemia (P<0.0001), ventilator duration (P=0.025), and length of hospital stay (P=0.002) were independent predictors of CABG postoperative complications.
Conclusion: Preoperative hypoalbuminemia was associated with postoperative mortality and complications, including hemorrhage, infection, stroke, and AKI development in patients undergoing CABG procedure. Thus, serum albumin measurement before CABG as a clinically implementable and easy method could be used for management and prevention of postoperative complications.