To evaluate whether postoperative administration of intravenous low-dose amiodarone and magnesium sulfate (MgSO(4)) combination would reduce the incidence of atrial fibrillation following coronary artery bypass grafting (CABG) in normomagnesemic high-risk patients for postoperative atrial fibrillation (POAF). A total of 136 patients undergoing elective CABG and had > or =3 risk factors for POAF were prospectively randomized to one of three groups, to receive a single dose of amiodarone (5 mg/kg) and MgSO(4) (1.5 g) (combination group, n = 44), or an equal dose of amiodarone (amiodarone group, n = 44) or equal volumes of saline (control group, n = 48) at early postoperative period. Continuous electrocardiographic (ECG) monitoring was performed for the first 48 hours and an ECG was recorded every 8 hours later. POAF longer than 30 minutes or for any length requiring treatment, and the drug-related side effects were recorded. The study population showed a homogeneous distribution regarding risk factors for POAF and there was no significant difference in patient characteristics, echocardiographic variables, or operative variables among three groups. POAF developed in 4 patients in combination group, in 16 patients in amiodarone group and in 16 patients in control group, representing a 24% relative risk reduction between the combination group and control group (p = 0.023). No statistically significant difference regarding incidence of POAF was observed between amiodarone and control groups. Combined prophylactic therapy with amiodarone and MgSO(4) at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients.

Background: There are few reports on postoperative late cardiac tamponade with surgical therapy in the literature. Methods: Hospital records of 87 patients with postoperative late cardiac tamponade who had undergone cardiac surgery between January 1999 and December 2003 were evaluated retrospectively. Results: Out of 8400 patients who had undergone cardiac surgery, 87 patients (1 %) had postoperative late cardiac tamponade. The incidence was 0.1 % for patients with coronary artery bypass grafting and 3.4 % for those with heart valve replacement (p < 0.01). Subxiphoid midline incision was carried out in 67 patients (77 %). Conversion to re-sternotomy was required in 8 patients due to either ineffective drainage (5 patients, 7.5 %) or laceration and bleeding (3 patients, 4.5 %). Re-sternotomy was undertaken in 20 patients with no complication. Early death occurred in 3 patients with subxiphoid drainage (3.5 %), two of which were related to bleeding. Out of 84 patients who survived, 10 patients had recurrent cardiac tamponade, 5 of which required surgical drainage (6 %). Conclusions: Bleeding due to dense adhesions between the epicardium and the sternum may be encountered during subxiphoid drainage for postoperative late cardiac tamponade and lead to a 3 % mortality rate. 1 Presented at the 53rd International Congress of The European Society for Cardiovascular Surgery, Ljubljana-Slovenıa, June 2 - 5, 2004

Background: The primary objective of this study was to test and compare the efficacy of currently available intraoperative blood salvage systems via a demonstration of the level of increase in percentage concentration of red blood cells (RBC), white blood cells 9WBC) and platelets (Plt) in the end product. Methods: In a prospective, randomized study, data of 80 patients undergoing elective cardiac surgery with cardiopulmonary bypass in a 6-month period was collected, of which the volume aspirated from the surgical field was processed by either the HemoSep Novel Collection Bag (Advancis Surgical, Kirkby-in-Ashfield, Notts, UK) (N=40) (Group 1) or a cell- saver (C.A.T.S Plus Autotransfusion System, Fresenius Kabi, Bad Homburg, Germany) (N=40) (Group 2). Results: Hematocrit levels increased from 23.05%±2.7 to 43.02%±12 in Group 1 and from 24.5±2 up to 55.2±9 in Group 2 (p=0.013). The mean number of platelets rose to 225200±47000 from 116400 ±40000 in the HemoSep and decreased from 125200±25000 to 96500±30000 in the cell-saver group (p=0.00001). The leukocyte count was concentrated significantly better in Group 1 (from 10100±4300 to 18120±7000; p=0.001). IL-6 levels (pg/dL) decreased from 223±47 to 83±21 in Group 1 and from 219±40 to 200±40 in Group 2 (p=0.001). Fibrinogen was protected significantly better in the HemoSep group (from 185±35 to 455±45; p=0.004). Conclusions: Intraoperative blood salvage systems functioned properly and the resultant blood product was superior in terms of red blood cell species. The HemoSep group had significantly better platelet and leukocyte concentrations and fibrinogen content.