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Abstract Background The characteristics of electrocardiogram (ECG) abnormalities related to cardiac channelopathies potentially linked to sudden cardiac death (SCD) are not widely recognized in Iran. We examined the prevalence of such ECG patterns and their related factors among adult residents of Tehran, Iran. Methods The clinical characteristics and 12-lead ECGs of Tehran Cohort Study participants were examined. Long QT intervals, short QT intervals, Brugada syndrome (BrS) patterns, and early repolarization (ER) were evaluated using computer-based assessment software validated by cardiologists. Logistic regression models were employed to identify the factors associated with the prevalence of different ECG patterns. Results Out of 7678 available ECGs, 7350 were included in this analysis. Long QT interval, ER pattern, BrS patterns, and short QT interval were found in 3.08%, 1.43%, 0.31%, and 0.03% of participants, respectively. The prevalence of long QT interval increased with age, opium consumption, and presence of hypertension. Younger age, lower body mass index (BMI), alcohol use and male sex were independently linked to an elevated prevalence of ER pattern. Most individuals with BrS patterns were men (95%) and had lower BMI, high- and low-density lipoprotein, and total cholesterol compared to those without the BrS pattern. At a mean follow-up of 30.2 ± 5.5 months, all-cause mortality in the group exhibiting abnormal ECG patterns (6.3%) was approximately twice as high as that in the group without such patterns (2.96%). Conclusion Abnormal ECG patterns corresponding to channelopathies were relatively rare among adult residents of the Tehran population, and their prevalence was influenced by various factors. Clinical trial number Not applicable.

Abstract Background Insufficient physical activity (PA) is a major risk factor for non-communicable diseases (NCDs) and one of the leading causes of premature mortality worldwide. This study examined the prevalence and independent determinants of insufficient PA among adults resident of Tehran utilizing Tehran Cohort Study Data (TeCS). Method We used the recruitment phase data from the TeCS with complete data on PA. PA was assessed through a Likert-scaled question and categorized into three groups. Utilizing data from the 2016 national census, the age- and sex-weighted prevalence of insufficient PA in Tehran was determined. The adjusted logistic regression model is used to neutralize influencing factors and determine the factors associated with insufficient PA. Result The weighted prevalence of insufficient PA was 16.9% among the 8213 adult citizens of Tehran, with a greater prevalence among females (19.0% vs. 14.8% among males). Additionally, older age groups, unemployed, housewives, and illiterate educated participants displayed a much higher prevalence of insufficient PA (p 30: 1.85, 95% CI: 1.56–2.18, p

Abstract Objectives Using the cardiac surgery database is of high importance in referral centers and can lead to a better quality of care for patients. Tehran Heart Center (THC) is a cardiovascular referral center that was inaugurated in 2001. In this report, we aimed to present the third report of trends in patients' cardiovascular risk factors and surgical procedures from 2002 to 2021 that have been gathered for all THC patients. Methods This serial cross-sectional study was conducted at Tehran Heart Center from 2002 to 2021. All patients undergoing cardiac surgeries were eligible to enter the study (N = 63,974). Those with miscellaneous types of surgeries were excluded (N = 9556). The distribution of cardiac surgeries (including isolated coronary artery bypass graft (CABG), isolated valve, and CABG + valve surgeries) and their respective in-hospital mortality were recorded. Furthermore, 20-year trends in the prevalence of various cardiovascular risk factors (CVRFs) among the following groups were evaluated: a) isolated CABG, b) aortic valve replacement/repair for aortic stenosis (AS/AVR/r), and c) isolated other valve surgeries (IVS). Results A total of 54,418 patients (male: 70.7%, age: 62.7 ± 10.8 years) comprised the final study population, with 84.5% prevalence of isolated CABG. Overall, the AS/AVR/r group was in between the CABG and IVS groups concerning CVRFs distribution. Excluding some exceptions for the AS/AVR/r group (in which the small sample size (N = 909) precluded observing a clear trend), all studied CVRFs demonstrated an overall rising trend from 2002 to 2021 in all three groups. Regarding in-hospital mortality, the highest rate was recorded as 4.0% in 2020, while the lowest rate was 2.0% in 2001. Conclusions Isolated CABG remained the most frequent procedure in THC. Notable, increasing trends in CVRFs were observed during this 20-year period and across various types of cardiac surgeries, which highlights the clinical and policy-making implications of our findings. Graphical Abstract

Abstract Background The prevalence and burden of substance and opium use have increased worldwide over the past decades. In light of rapid population changes in Tehran, we aimed to evaluate the prevalence of opium and other substance use among adult residents in Tehran, Iran. Method From March 2016 to March 2019, we utilized data from 8 296 participants in the Tehran Cohort Study recruitment phase (TeCS). We calculated the age-sex-weighted prevalence of substance use and the geographic distribution of substance use in Tehran. We also used logistic regression analysis to determine possible determinants of opium use. Result We analyzed data from 8 259 eligible participants with complete substance use data and the average age of participants was 53.7 ± 12.75 years. The prevalence of substance use was 5.6% (95% confidence interval [CI]: 4.6- 7.1%). Substance use was more common in males than females (Prevalence: 10.5% [95% CI: 8.6- 12.6%] vs. 0.5% [95% CI: 0.2- 1.2%], respectively). The age-sex weighted prevalence of substance use was 5.4% (95% CI: 4.6-7.1%). Moreover, opium was the most frequently used substance by 95.8% of substance users. Additionally, we found that male gender (Odds ratio [OR]: 12.1, P

Abstract Background Revascularization in diabetic patients with coronary artery disease remains a challenge in cardiology practice. Although clinical trials have reported the mid-term superiority of coronary artery bypass grafting (CABG) surgery over percutaneous coronary intervention in these patients, little is known about the long-term outcomes of CABG in diabetic patients compared to non-diabetics, particularly in developing countries. Methods Between 2007 and 2016, we recruited all patients who underwent isolated CABG in a tertiary care cardiovascular center in a developing country. The patients were followed at 3–6 months and 12 months after surgery, and then annually. The study endpoints were 7-year all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). Results Of 23,873 patients (17,529 males, mean age 65.67 years) who underwent CABG, 9227 (38.65%) patients were diagnosed with diabetes. After adjustment for potential confounders, patients with diabetes experienced a 31% increase in MACCE seven years after surgery compared to the non-diabetic patients (HR = 1.31, 95% CI: 1.25–1.38, P-value

Abstract Introduction Tobacco use is a major health concern worldwide, especially in low/middle-income countries. We aimed to assess the prevalence of cigarette smoking, waterpipe, and pipe use in Tehran, Iran. Methods We used data from 8272 participants of the Tehran Cohort Study recruitment phase. Tobacco use was defined as a positive answer to using cigarettes, waterpipes, or pipes. Participants who did not report tobacco use during the interview but had a previous smoking history were categorized as former users. Age- and sex-weighted prevalence rates were calculated based on the national census data, and characteristics of current and former tobacco users were analyzed. Results Age- and sex-weighted prevalence of current tobacco users, cigarette smokers, waterpipe, and pipe users in Tehran was 19.8%, 14.9%, 6.1%, and 0.5%, respectively. Current tobacco use was higher in younger individuals (35–45 years: 23.4% vs. ≥ 75 years: 10.4%, P 12 years: 19.3% vs. illiterate: 9.7%, P

Abstract Background The prevalence of type 2 diabetes mellitus has increased in the past decades. We investigated the prevalence of diabetes and its awareness, treatment, and control among adult residents of Tehran. Methods We used the recruitment phase data of the Tehran Cohort study, enrolling a random sample of adult residents of Tehran aged ≥35 years. Diabetes was defined as self-report, current use of glucose-lowering medications, and/or fasting plasma glucose (FPG) ≥126mg/dl. Impaired fasting glucose (IFG) was defined as an FPG of 100-125mg/dl. Awareness was defined as diabetes self-report, treatment as receiving glucose-lowering medications, and glycemic control as FPG

Abstract Background Recent research suggests a protective role for positive family history of premature cardiovascular disease (FHpCVD) in patients undergoing coronary artery bypass grafting. We aimed to further investigate this unlikely association. Methods In this registry-based cohort study, patients who underwent first-time non-emergent coronary bypass surgery at Tehran Heart Center between 2007 and 2016 were included. Patients with and without FHpCVD were compared in terms of all-cause mortality and first non-fatal cardiovascular events (CVEs) comprising non-fatal acute coronary syndrome, non-fatal stroke or transient ischemic attack, and repeat coronary revascularization. Results A total of 13,156 patients were included (mean age 60.83 ± 9.57, 74.5% male), among which 2684 (20.4%) patients had FHpCVD. Median follow-up was 77.7 months. FHpCVD was weakly associated with reduced all-cause mortality using inverse probability weight (IPW) method (hazard ratio [HR] = 0.853; 95% confidence interval [CI] 0.730–0.997; P = 0.046), and not associated with non-fatal CVEs considering death as the competing event (sub-distribution HR [SHR] = 1.124; 95% CI 0.999–1.265; P = 0.053). Within a subgroup of patients without previous myocardial infarction or revascularization (7403 cases; 56.3%), FHpCVD was associated with lower mortality (HR = 0.700; 95% CI 0.548–0.894; P = 0.004) and higher non-fatal CVEs (SHR = 1.197; 95% CI 1.019–1.405; P = 0.028), whereas among patients with previous coronary events, there was no association between FHpCVD and outcomes. Conclusions FHpCVD was associated with lower all-cause mortality but higher non-fatal CVEs, especially in those without prior coronary events. Such discordance calls for caution in assuming a protective role for FHpCVD. The prognostic significance of FHpCVD needs further evaluation among surgical patients.

Background: High levels of blood pressure (BP) remain undetected and poorly controlled in large segments of the population leading to an enormous burden in terms of disease and mortality. Objective: We aimed to assess the prevalence, awareness, treatment, and control of hypertension in Tehran. Methods: We used the data of 8,296 adults aged ≥35 years from the Tehran Cohort Study who were enrolled between May 2016 and February 2019. Hypertension was defined as systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg, self-report, and/or current antihypertensive medication use. The age- and sex-weighted prevalence of hypertension and high normal BP was calculated using the 2016 national census. Furthermore, awareness, treatment, and control of hypertension were analyzed. Results: The mean age of the participants was 53.8 ±12.75 years, and 54.0% were women. The weighted prevalence of hypertension and high normal BP were 36.5% and 12.2%, respectively. Among hypertensive individuals, 68.2% were aware of hypertension, 53.3% were receiving medication, and 40.4% had adequate BP control. The awareness, treatment, and control of hypertension were significantly higher in women (72.2% vs. 63.4% [P < 0.001], 55.1% vs 51.1% [P = 0.020], and 42.7% vs. 37.7% [P = 0.004], respectively) and this gap considerably increased with advancing age. Hypertension was more prevalent in northern Tehran but with a better treatment rate and control in the same regions. Conclusion: Despite the high prevalence of hypertension in the adult population of Tehran, the rates of awareness, treatment, and control of hypertension are unsatisfactory and demand comprehensive strategies to improve this situation, especially in younger men.

BackgroundThere are conflicting results regarding the relationship between overweight/obesity and the outcomes of coronary artery bypass graft surgery (CABG), termed "the obesity paradox". This study aimed to evaluate the effects of body mass index (BMI) on the midterm outcomes of CABG.MethodsThis historical cohort study included all patients who underwent isolated CABG at our center between 2007 and 2016. The patients were divided into five categories based on their preoperative BMIs (kg/m2): 18.5≤BMIResultsOf 17 751 patients (BMI = 27.30 ±4.17 kg/m2) who underwent isolated CABG at our center, 17 602 patients (mean age = 61.16±9.47 y, 75.4% male) were included in this study. Multivariable analysis demonstrated that patients with pre-obesity and normal weight had similar outcomes, whereas patients with preoperative BMIs exceeding 30 kg/m2 kg/m2 had a significantly higher risk of 5-year all-cause mortality and 5-year MACCEs than those with pre-obesity. Additionally, a positive association existed between obesity degree and all-cause mortality and MACCEs. Further, BMIs of 40 kg/m2 or higher showed a trend toward higher MACCE risks (adjusted hazard ratio, 1.32; 95% confidence interval, 0.89 to 1.95), possibly due to the small sample size. A nonlinear, albeit negligible, association was also found between continuous BMI and the study endpoints.ConclusionsOur findings suggest that preoperative obesity (BMI>30 kg/m2) in patients who survive early after CABG is associated with an increased risk of 5-year all-cause mortality and 5-year MACCEs. These findings indicate that physicians and cardiac surgeons should encourage patients with high BMIs to reduce weight for risk modification.

Cardiovascular disease, mental health, and injury are among the top health issues globally. In Tehran Cohort Study, we aimed to determine the prevalence, incidence, and trend of cardiovascular diseases, psychiatric symptoms, injury, and risk factors in Tehran households. We enrolled 4215 households in the recruitment phase from March 2016 to March 2019. Demographic characteristics, past medical history, medications, and familial history of the participants were collected. Rose angina pectoris, general health Questionnaire-28 (GHQ-28), and injury questionnaires were completed. Fasting blood samples were collected to measure routine biochemistry and store samples in the biobank. Anthropometric and physiological measurements and electrocardiograms were performed. The participants are followed every three years for up to 12 years. In total, 8296 individuals participated in the cardiovascular section, 10247 completed the GHQ-28, and 4167 households completed the injury questionnaire. The mean age of the participants was 48.2 (16.41), and 46.5% were male. 64.3% of recruited individuals had no symptoms of psychiatric disorders, and 3729 (89.5%) households did not have any severe injury requiring treatment. The participants' diversity and their invaluable data will help us provide a general picture of the current prevalence and incidence of the main study objectives.

Existence of fungi and disinfection by-products (DBPs) in public swimming pools water are dangerous since it can seriously affect on health of swimmers. This data study aimed to determine the fungi contamination and DBPs concentration including trihalomethanes (THMs), haloacetic acids (HAAs), halamines and cyanogen halides and haloacetonitriles (HANs) of swimming pools (chlorine based) in Gonabad County, Iran. So, the fungal load and DBPs concentration were investigated in two swimming pools in the middle of spring of 2017 by collecting a number of 9 water samples and 9 samples of lateral facilities of each pool by membrane filtration technique and sterile carpet. The DBPs concentrations were measured by gas chromatograph technique. The results showed that the pools were contaminated with Dermatophyte (trichophyton mentagrophytes and epidermophyton flucosomes), yeasts, and more with opportunistic saprophytic fungi. 24.8%, 22.7%, 16.9%, and 11.4% saprophytic fungi were separated from pool side, locker room, pool water, and shower positions, respectively. 7.4% and 3.2% of yeast fungi as well as 0.23% and 0.2% of dentofacies of causative agents of tinea were separated from the pools water and showers as well as locker room and shower positions, respectively. According to the data, halamines and cyanogen halides had the highest concentrations, followed by HAAs, THMs and HANs respectively. Among the halamines and cyanogen halides, HAAs, THMs and HANs, trichloramine acid was the most dominant species, followed by trichloroacetic acid and dichloramine, respectively. Keywords: Swimming pools, Disinfection, Fungi contamination, DBPs, HAAs, THMs, HANs

The data was obtained from fluoride ion concentrations determined in groundwater sources of Gonabad. A number of 144 samples from 12 drinking groundwater wells located in different regions at the mid of spring, summer, autumn and winter from each regions, were collected from spring 2016 to spring of 2017. The fluoride ions in the samples were determined through the SPADNS colorimetric method at a wavelength of 580 nm. Dispersion of fluoride ions in terms of concentration in groundwater resources of Gonabad was planned using geographic information system (GIS) base on inverse distance weighted (IDW) method. The data showed that lowest and highest concentration of fluoride ions were determined 0.46 in winter and 1.56 mg/l in summer season, respectively. The average, max and min amount of fluoride concentration in groundwater resources of Gonabad were 0.67 ± 0.03, 1.56 and 0.46 mg/L, respectively. The average chemical parameters concentration of Potassium, Sodium, Magnesium, Calcium, Phosphate, Nitrate, Bicarbonate, Sulfate and Chloride were 6.61 ± 1.2, 281.17 ± 3.08, 26.75 ± 2.55, 68.14 ± 3.89, 0.2 ± 0.04, 10 ± 1.83, 275.02 ± 7.20, 282.08 ± 5.04 and 235 ± 5.83 mg/L, respectively. Keywords: Groundwater, Fluoride, Fluorosis, Gonabad, Water quality, GIS

Background: Depression is one of the major psychiatric disorders in the world. The present study was conducted to determine the prevalence of depression among Iranian school students through a meta-analysis. Methods: All national and international information databases including PubMed, Scopus, Web of Science, SID, Magiran, Medlib were searched. The search phase was performed without language and time restrictions, but the searched studies were all in Persian and English, and the sources were updated by 03.08.2020. As the selected studies had high heterogeneity, the random effects model was used. Results: In 51 studies with a sample of 537144 people, the prevalence of depression in Iranian school students was 37% (95%CI: 32, 42). In addition, the prevalence of depression in girl school students was 45% (95%CI: 25-65) and in boys was 28% (95%CI: 20-35). The prevalence of mild, moderate and severe depression in school students is 31%, 18% and 11%, respectively. Also, the prevalence of depression in primary school students was 12%, middle school students 32%, high school students 47% and pre-university students 46%. Conclusions: About a third of Iranian school students suffer from some degree of depression, and the prevalence of depression in girls is about twice that of boys. The prevalence of mild depression among school students is higher than moderate and severe depression. On the other hand, the prevalence of depression in school students from primary to pre-university level is increasing, which is very worrying.

Background: Postoperative atrial fibrillation (POAF) is probably a consequence of inflammation. Vitamin D is known for its anti-inflammatory properties. The aim of this study was to evaluate the effects of vitamin D levels on the incidence of POAF. Methods: In a prospective cohort study, patients were monitored for the occurrence of POAF during the first 5 days after coronary artery bypass grafting surgery in Tehran Heart Center. Those with concomitant valvular surgeries were excluded. Thereafter, they were divided into 2 groups: with or without POAF. Vitamin D levels were assessed in all the patients. The relationship between the vitamin D level and the incidence of POAF was evaluated and compared between the groups using the Mann–Whitney U test. Results: The study population comprised of 156 patients. The mean age was 62.8±8.6 years, and 105 (67.3%) patients were male. Of the 156 patients, 29 (19%) developed POAF. The median preoperative vitamin D level was 15.3 in the group with POAF and 25.3 in the group without POAF (P=0.07). Conclusion: Our results demonstrated no significant relationship between vitamin D levels and the occurrence of POAF.

Objective: Depressed coronary artery disease (CAD) patients may experience a poorer prognosis than non-depressed patients. The aim of this study was to find the associated factors for depressive symptoms in young adults with CAD. Method: This was a cross-sectional study within Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Young adult CAD patients (men ≤ 45 year-old and women ≤ 55 year-old) were visited from March 2013 to February 2014. Demographic, clinical and laboratory data were collected and all patients were asked to fill in the Beck Depression Inventory II. Informed consent was obtained from all participants. A logistic regression model was used to find multiple associated factors of depressive symptoms. Results: Seven hundred seventy patients (mean ±SD age: 45.34 ±5.75 y, men: 47.7%) were visited. The point prevalence of depressive symptoms was 46.9% in women and 30.2% in men (p < 0.001). Logistic regressions model revealed that the most important associated factors for depressive symptoms in the male premature CAD patients were opium usage (OR: 2.4, 95% CI: 1.33-4.43), major adverse cardiac events (MACE) (OR: 2.2, 95% CI: 1.17-3.93), initial coronary artery bypass grafting (CABG) treatment (OR: 2.1, 95% CI: 1.07-4.06), positive family history for CAD (OR: 1.8, 95% CI: 1.11-3.01) and cigarette smoking (OR: 1.7, 95% CI: 0.97-2.98). Hypertension showed a protective role in this group of patients (OR = 0.5, CI = 0.29-0.92). In the female patients, hypertension (OR = 1.5, CI = 0.96-2.22) and body mass index (BMI) (OR = 1.1, CI = 1.02-1.10) were associated with depressive symptoms. Conclusion: In premature CAD male patients, opium usage, MACE, initial CABG treatment, positive family history for CAD and cigarette smoking were associated with depressive symptoms; and hypertension and BMI were associated with depressive symptoms in women.

Anxiety may negatively affect the course of coronary artery disease (CAD). The aim of this study was to assess which factors are associated with anxiety in young adults with CAD. A cohort of individuals with premature coronary artery disease was formed between 2004-2011, as the Tehran Heart Center's Premature Coronary Atherosclerosis Cohort (THC-PAC) study. Patients (men≤45-year-old, and women≤55-year-old) were visited between March 2013 and February 2014. All participants were examined, and their demographic, clinical, and laboratory data were collected. Then, all participants filled in the Beck Anxiety Inventory. Logistic regression models were used to identifying factors related to anxiety in both sexes. During the study, 708 patients (mean [SD] age: 45.3 [5.8] y, men:48.2%) were visited. Anxiety was present in 53.0% of participants (66.0% of women and 39.0% of men). The logistic regressions model showed that the associated factors for anxiety in men were opium usage (OR=1.89, 95% CI: 1.09-3.27), positive family history (OR=1.49, 95% CI:0.94-2.35), and creatinine serum level (OR=1.17, 95% CI:1.05-1.303); and in women were major adverse cardiac events (MACE) during follow-up (OR=2.30, 95% CI:1.25-4.23), hypertension (OR=1.71, 95% CI:1.07-2.73) and the duration of CAD (OR=0.99, 95% CI:0.98-1.00). In premature CAD patients, the determinants of anxiety seem to be different in each sex. Opium usage, positive family history of CAD, and creatinine serum levels in men, and MACE, hypertension, and duration of CAD in women appear the relevant factors in this regard.

Background: Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching. Methods: This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI). Results: The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274). Conclusion: In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.

Background: During last decades mechanical ventilation has been an important support in the postoperative management of patients undergoing cardiac surgery. This study was designed to determine the predictors of prolonged mechanical ventilation (PMV) in patients undergoing heart valve surgery. Methods: This retrospective study considered of 1056 patients who underwent isolated valve surgery at Tehran Heart Center from March 2002 to March 2009. PMV is considered as mechanical ventilation period of ≥24 hours at postoperative hospital stay in this study. Results: PMV occurred in 6.6% of patients. Initial ventilation hours, atrial fibrillation, cardiac arrest and reintubation were the most prevalent postoperative complications. Preoperative renal failure, postoperative stroke, intra aortic balloon pump insertion, emergent operation, complete heart block, longer perfusion time were independent predictors of PMV in our patients. Conclusion: PMV is associated with significant comorbidities and increased hospital mortality. Strategies to delineate the patients at risk and to modify these risk factors by prophylactic measures should probably lead to a lower incidence of prolonged mechanical ventilation for patients undergoing isolated valve surgery.

Background: Postoperative neurological injuries, including cognitive dysfunction, sleep disorder, delirium, and anxiety, are the important consequences of coronary artery bypass graft surgery (CABG). Evidence has shown that postoperative sleep disturbance is partly due to disturbed melatonin secretion in the perioperative period. The aim of this study was to evaluate the effect of melatonin on postoperative sleep disorder in patients undergoing CABG. Method: One hundred forty-five elective CABG patients participated in a randomized double-blind study during the preoperative period. The patients were randomized to receive either 3 mg of melatonin or 10 mg of Oxazepam one hour before sleep time. Each group received the medication from 3 days before surgery until the time of discharge. Sleep quality was evaluated using the Groningen Sleep Quality Score (GSQS), and the incidence of delirium was evaluated by nursing records. Sleep quality and anxiety scores were compared before and after surgery through the Wilcoxon signed-rank test. The analysis of covariance (ANCOVA) and independent t-test were used to compare the sleep and anxiety scores between the groups. P values ≤ 0.05 were considered statistically significant. Results: Totally, 137 patients at a mean age of 60 years completed the study (76% male). The analysis of the data showed that sleep was significantly disturbed after surgery in both groups. The patients in the Oxazepam group demonstrated significantly higher disturbance in their mean postoperative GSQS score than did their counterparts in the melatonin group (p value < 0.001). A smaller proportion of the participants experienced delirium in the melatonin group (0.06%) than in the Oxazepam group (0.12%); however, this difference was not statistically significant. Conclusion: The result of the present study revealed that melatonin improved sleep in post-cardiac surgery patients more than what was observed with Oxazepam. Therefore, melatonin may be considered an effective alternative for Benzodiazepines in the management of postoperative sleep disorder.

Background: We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting.Methods: A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiacsurgery at Tehran Heart Center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 (81.48%) of these patients.Results: The patients’ age ranged between 20 and 84 years (mean: 58.33, SD: 10.08 years). Of the 1604 patients studied,1186 (73.9%) were men, 592 (36.9%) had diabetes, 598 (37.3%) were smokers, and 194 (12.1%) cases had significant left main stenosis. Twenty-one (1.3%) patients had significant carotid stenosis (> 60% stenosis), which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 (1.4%) of the patients without carotid stenosis. Magnetic resonance angiography (MRA) was conducted in 15 patients. In our univariate analysis, female gender (p value = 0.023),hypertension (p value = 0.055), peripheral vascular disease (p value < 0.001), and age (p value = 0.001) were significantin the development of carotid stenosis.Conclusion: Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, female gender, and advanced age.

Background: Moderate non-organic tricuspid regurgitation (TR) concomitant with coronary artery disease is not uncommon. Whether or not TR improves after pure coronary artery bypass grafting (CABG), however, is unclear. The aim of this study was to evaluate the effect of isolated CABG on moderate non-organic TR.Methods: This study recruited 50 patients (40% female, mean age: 65.38±8.01 years, mean left ventricular ejection fraction (LVEF): 45.74±13.05%) with moderate non-organic TR who underwent isolated CABG. TR severity before and after CABG was compared. Pulmonary arterial systolic pressure (PAPs)>30mmHg and LVEF

Acinetobacter lwoffii, an important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia.

Objective(s): To determine One-month survival after CABG in Shariati Hospital. Methods: We followed 340 patients who underwent Isolated-CABG in Shariati Hospital and used survival analysis to compare common coronary risk factors and to assess surgical factors related to survival after CABG. Results: Smoking was more prevalent in males than in females but prevalence of hypertension, diabetes and hperlipidemia was greater in women. Female subjects were older, had greater Body Mass Index (BMI) and left ventricular ejection fraction (LVEF) and had undergone more non-elective surgery compared to males. Most patients had received 3 or 4 grafts (range 1-6 grafts). There was no difference in aortic cross clamp and anesthesia time between the two genders. Females were hospitalized for longer periods after surgery and their mortality rates were greater. One-month survival ratio estimated by the Kaplan Meier method was 97.1% and 88.4% in males and females respectively. The overall survival rate was 95.3%. Conclusion: The factors related to poor survival were: female gender, non-elective surgery, lengthy aortic cross clamp and anesthesia time and the history of: hypertension, hyperlipidemia, previous CABG and CCU hospitalization.

Background: Prosthetic valve endocarditis (PVE) is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. Methods: The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues (Duke criteria). The analysis included a detailed study of hospital records. The continuous variables were expressed as mean ± standard deviation, and the discrete variables were presented as percentages.Results: Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9±12.8 years. Women made up 53.8% of all the cases. Early PVE was detected in 6 (46.2%) patients, and late PVE occurred in 7 (53.8 %). Eleven (84.6%) patients were treated with intravenous antimicrobial therapy, and the other two (15.4%) required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% (2 patients). Conclusion: It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk.

Background: Discrete subaortic stenosis (DSS) is a progressive condition. Controversy still rumbles on as to whether the subaortic membrane causes aortic regurgitation (AR) and whether membrane resection reduces AR severity. We investigated the association between the left ventricular outflow tract peak gradient (LVOT-PG) and AR severity preoperatively and changes in AR severity and obstruction recurrence after surgery in DSS patients.Methods: Twenty patients were evaluated before and after surgery for DSS (mean follow-up time: 13.60±9.61 months). The patients were evaluated via transthoracic echocardiography and transesophageal echocardiography, if necessary. The cut-off point for surgery was LVOT-PG ≥50 mmHg or the presence of progressive AR.Results: The mean age of the patients was 28.55±15.23 years, and 35% of them were male. LVOT-PG decreased from a mean of 80.83±42.72 mmHg preoperatively to 19.14±14.03 mmHg postoperatively and to 25.47±16.10 at follow-up. AR was identified in 15 (75%) patients preoperatively: mild in 8 (40%) and moderate in 7 (35%). The postoperative change in AR severity was insignificant. The correlation between preoperative LVOT-PG and the incidence and severity of preoperative AR was not significant. AR severity had no correlation with age. Membrane recurrence occurred in 25% of the patients. Conclusion: Our results indicated no relationship between AR severity and LVOT-PG and the patient’s age. Patient selection for surgery can, therefore, be carried out on the basis of LVOT-PG or AR severity separately. Subaortic resection may reduce AR severity in some patients, but this reduction is not significant. Future studies are required to elucidate whether or not the presence of the AR is an indication for surgery.

Background: This study was undertaken to compare the outcome in patients with moderate to severe ischemic mitral regurgitation (IMR) undergoing coronary artery bypass grafting (CABG) with either mitral valve repair or mitral valve replacement.Methods: Between March 2002 and February 2005, 49 consecutive patients (mean age: 62.84±8.42 years; mean EuroSCORE: 10.03±3.12) with coronary artery disease and moderate to severe IMR underwent CABG plus mitral valve replacement or mitral valve repair. The patients with annulus dilatation were more likely to undergo repair. The mean follow-up period was 18.89±2.1 months.Results: 40.8% of the patients underwent CABG plus mitral valve replacement, and 59.2% had CABG concomitant with mitral valve repair. The total rate of mortality in our population was 14.9% (7 patients) including 10.3% (3 patients) early mortalities; all the deceased patients were in the repair group. Both groups had a similar EuroSCORE, but more patients in the repair group had a recent episode of unstable angina (65.5% vs. 35.0%, respectively; P=0.035) and diabetes mellitus (44.8% vs. 10.0%, respectively; P=0.009). After the follow-up period, in the repair group, 11.5% had no features of Mitral regurgitation (MR); while 50% had mild MR, 23.1% moderate MR, 11.5% moderately severe MR, and 3.8% severe MR. Overall, 68.9% had no or mild MR, which we defined as successful repair, and 31.1% had moderate to severe MR. Success of repair and mortality were not statistically related to preoperative ejection fraction (39.2±7.8% vs. 32.5±8.5%; P=0.057). Conclusion: Early mortality was higher in the repair group than that in the replacement group, but this may have been due to the higher frequency of diabetes mellitus and unstable angina in the former group. Future studies are required to determine the benefit of repair versus replacement concomitant with CABG in IMR patients.

Background: The presence of significant carotid stenosis in coronary artery bypass grafting (CABG) patients increases the risk of either transient ischemic attack or stroke. However, there is a dearth of data on the risk for patients with unilateral total occlusion of the carotid artery. We herein report our results of cardiac surgery in patients with unilateral total occlusion of the carotid artery. Methods: We examined 10,000 patients who underwent carotid artery duplex scanning before CABG or other cardiac procedures between January 2001 and September 2006 at Tehran Heart Center. The occlusions were detected via carotid Doppler screening and were confirmed through conventional or MR angiography. Among these patients, 15 (0.15%) patients had unilateral total occlusion of the internal carotid artery, and all of them underwent elective cardiac surgery. During cardiopulmonary bypass, the mean arterial pressure was maintained at above 60 mmHg with vasopressure drugs and increasing flow pump.Results: There were 4 patients with left and 11 patients with right carotid occlusions. Four patients had a history of cerebrovascular accident. The mean cross-clamp time (min) and perfusion time (min) was 50.7±17.3 and 94.2±26.7, respectively. The mean graft number was 4.1±0.9. One of these patients expired intraoperatively because of low cardiac output. In one (6.66%) patient, postoperative cerebrovascular accident occurred on the contralateral side of the totally occluded region. All the patients recovered uneventfully. Conclusion: Our results suggest that CABG can be performed in patients with unilateral total occlusion of the internal carotid artery without ipsilateral stroke using our strategies.

Background: The objective of this study was to evaluate the effect of a hospital-based cardiac rehabilitation program on heart rate recovery (HRR) in patients who received percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). Methods: Two hundred forty patients, who completed 24 sessions of a cardiac rehabilitation program (phase 2) after PCI (n=62) or CABG (n=178) at the rehabilitation department of Tehran Heart Center were included in the present study. Demographic and clinical characteristics and exercise capacity at baseline and at follow-up were compared between the two groups. The main outcome measurements were: Resting heart rate, peak heart rate, and HRR.Results: All the patients showed significant improvements in heart rate parameters from the baseline to the last sessions. The profile of atherosclerotic risk factors (except for diabetes mellitus) was similar between the PCI and CABG subjects. After eight weeks of cardiac rehabilitation, HRR increased averagely about 17 and 21 bpm among the CABG and PCI patients, respectively (p=0.019). Conclusion: The results of the present study were indicative of an increase in HRR over 1 minute in patients irrespective of their initial revascularization modality (i.e. PCI or CABG) after the completion of cardiac rehabilitation. Be that as it may, the PCI patients achieved greater improvement in HRR by comparison with the CABG patients.

Background: Dilated cardiomyopathy is associated with a progressive deterioration in cardiac function and eventually death. Initial interest in this hypothesis was to create another large animal model for dilated cardiomyopathy in addition to pigs and dogs.Methods: After the induction of anesthesia to 10 female sheep, a carotid-jugular shunt was created in all the animals via a 1-cm fistula between the carotid artery and jugular vein. Six sheep out of the total of 10, were given intravenous Doxorubicin. Echocardiographic studies were performed before surgery and 3 months after that. The 4 animals not injected with Doxorubicin were evaluated for echocardiographic parameters after one year. Results: There was no abnormality in echo parameters in the 4 sheep that had not received Doxorubicin; in addition, their valves and cardiac output were normal. As regards the six sheep injected with Doxorubicin, 4 received a dose of 2 mg/kg weekly and expired after the second injection due to the toxicity of the drug, 1 was given Doxorubicin 1 mg/kg and died after one week, and 1 had Doxorubicin 0.5 mg/kg but showed no abnormality in terms of dilated cardiomyopathy. Conclusion: We conclude that the sheep is sensitive to Doxorubicin and that the dosage that is enough for creating dilated cardiomyopathy in dogs is very toxic for the sheep.

Background: Left ventricular dysfunction is one of the most powerful predictors of early and late outcomes in patients who undergo coronary artery bypass grafting (CABG). The aim of this study was to assess the early results of CABG that predict 30-day mortality and prolonged length of hospital stay (LOS) after CABG in patients with an ejection fraction (EF) of 30% or less. Methods: Seven hundred seven patients who underwent CABG with EF≤30% in Tehran Heart Center between January 2002 and January 2006 were entered and compared with 9467 patients with EF>30% as the control group. Demographic and clinical characteristics and postoperative complications were considered. Results: The thirty-day mortality rate (2.3% vs. 0.8%, P

Background: Coronary angiography, albeit a safe procedure, may cause serious complications especially in patients with left main stenosis (LMS). This study was designed to investigate the efficacy of workload achieved by exercise tolerance test (ETT) in predicting LMS in candidates for coronary angiography. Methods: A total of 743 patients with a positive ETT who subsequently underwent cardiac catheterization were retrospectively studied. Different risk factors were compared among the patients with and without LMS. A multivariate forward stepwise logistic regression analysis was used to identify the main predictors of LMS.Results: Among our 743 patients, 72% were male and 41(5.5%) had LMS≥50%. Patients with LMS, by comparison with those without LMS, were older and were more likely to be male and had higher percentages of ejection fraction less than 35% (EF≤35%), history of myocardial infarction, and lower metabolic equivalent (METs). After adjusting for important variables, we found that EF≤35%, METs, and the male sex were significant independent predictors of LMS (P7, LMS was found in 8.3% and 3.6%, respectively (P=0.006). The risk of having LMS in the men with METs≤7 was higher than that in those with METs>7 (OR=3, P=0.003, 95% CI=1.50-6.00). Among the patients with LMS, stenosis≥70% was found in 44% in METs≤7 and 18.8% in METs>7. Conclusion: Lower METs correlated with an increased likelihood of significant LMS in the patients, especially if they were male, who had a positive exercise test and were suspected of coronary artery disease. It is, therefore, advisable that patients with METs≤7 receive due attention during coronary angiography.

Background: Age is one of the most important factors that have consistently emerged as the most potent predictors of mortality and morbidity after coronary artery bypass graft (CABG) surgery. However, early results of CABG in young patients in comparison with elderly ones have been different in previous surveys. The aim of this study was to compare short-term mortality and morbidity in young versus older patients and evaluate the presence of risk factors and their influence on outcome in both groups. Methods: We conducted a retrospective database review of 13222 patients divided into two age groups: patients less than 40 years old (411 patients) and those older (12811 patients), who underwent CABG at Tehran Heart Center between January 2002 and January 2007. We also compared preoperative, operative, and postoperative characteristics between them and assessed the influence of the variables on the length of stay in hospital (LOS) in the two groups. Results: Among postoperative complications, only atrial fibrillation (P

Background: The Adult Cardiac Surgery Databank (ACSD) of Tehran Heart Center was established in 2002 with a view to providing clinical prediction rules for outcomes of cardiac procedures, developing risk score systems, and devising clinical guidelines. This is a general analysis of the collected data. Methods: All the patients referred to Tehran Heart Center for any kind of heart surgery between 2002 and 2008 were included, and their demographic, medical, clinical, operative, and postoperative data were gathered. This report presents general information as well as in-hospital mortality rates regarding all the cardiac procedures performed in the above time period. Results: There were 24959 procedures performed: 19663 (78.8%) isolated coronary artery bypass grafting surgeries (CABGs); 1492 (6.0%) isolated valve surgeries; 1437 (5.8%) CABGs concomitant with other procedures; 832 (3.3%) CABGs combined with valve surgeries; 722 (2.9%) valve surgeries concomitant with other procedures; 545 (2.2%) surgeries other than CABG or valve surgery; and 267 (1.1%) CABGs concomitant with valve and other types of surgery. The overall mortality was 205 (1.04%), with the lowest mortality rate (0.47%) in the isolated CABGs and the highest (4.49%) in the CABGs concomitant with valve surgeries and other types of surgery. Meanwhile, the overall mortality rate was higher in the female patients than in the males (1.90% vs. 0.74%, respectively). Conclusion: Isolated CABG was the most prevalent procedure at our center with the lowest mortality rate. However, the overall mortality was more prevalent in our female patients. This database can serve as a platform for the participation of the other countries in the region in the creation of a regional ACSD.

Background: There is controversy over the potential benefits/harms of the usage of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) as regards the postoperative mortality of coronary artery bypass grafting (CABG). This study investigates the correlation between the in-hospital mortality of CABG and the preoperative administration of ACEI/ARB. Methods: Out of 10055 consecutive patients with isolated CABG from 2006 to 2009, 4664 (46.38%) patients received preoperative ACEI/ARB. Data were gathered from the Cardiac Surgery Registry of Tehran Heart Center. In-hospital mortality was defined as death within the same admission for surgery. Adjusted for confounders, multivariable logistic regression models were used to evaluate the impact of preoperative ACEI/ARB therapy on in-hospital death. Results: The mean age of the patients was 60.04 ± 9.51 years and 7364 (73.23%) were male. Eighty-seven (0.86%) patients expired within 30 days. Multivariate analysis revealed that the administration of ACEI/ARB significantly protected against in-hospital deaths inasmuch as there were 33 (0.70%) vs. 54 (1.0%) deaths in the ACEI/ARB positive and negative groups, respectively (OR: 0.628; p value = 0.09). Patients without ACEI/ARB were more likely to have a higher global ejection fraction. Conclusion: Preoperative ACEI usage in patients undergoing CABG can be associated with decreased in-hospital mortality. Large-scale randomized clinical trials are suggested.

Background: L-carnitine has been demonstrated to confer cardiac protection against ischemia reperfusion injury in animals. This study evaluates the effects of L-carnitine administration on cardiac biomarkers after coronary artery bypass graft (CABG) surgery. Methods: One hundred thirty-four patients undergoing elective CABG surgery, without a history of myocardial ischemia or previous L-carnitine treatment, were enrolled and randomly assigned to an L-carnitine group ([n = 67], 3000 mg/d, started 2 days preoperatively and continued for 2 days after surgery) or a control group (n = 67). CK-MB (creatine kinase, muscle- brain subunits) and troponin T (TnT) levels were assessed in all the patients before surgery as baseline levels and at 8 and 24 hours postoperatively. Results: Our study included 134 patients (99 [73.8%] males) at a mean ± SD age of 59.94 ± 8.61 years who were candidates for CABG and randomized them into control or L-carnitine groups. The baseline demographic characteristics, including age (60.01 ± 9.23 in the L-carnitine group vs. 59.88 ± 7.98 in the control group) and sex (54 [80.6%] in the L-carnitine group vs. 45 [67.2%] in the control group) did not show any significant differences (p value=0.93 and 0.08, respectively). Patients in the L-carnitine group had lower levels of CK-MB (mean ± SD, 25.06 ± 20.29 in the L-carnitine group vs. 24.26 ± 14.61 in the control group), but the difference was not significant (p value = 0.28). TnT levels also showed no significant differences between the two groups (399.50 ± 378.91 in the L-carnitine group vs. 391.48 ± 222.02 in the control group; p value = 0.34). Conclusion: In this population of intermediate- to high-risk patients undergoing CABG surgery, L-carnitine did not reduce CK-MB and TnT levels.

Background: Data on premature coronary artery disease (CAD) are scarce. The Tehran Heart Center's Premature Coronary Atherosclerosis Cohort Study (THC-PAC) is the first study of its kind in the Middle East to assess major adverse cardiac events (MACE) in young CAD patients. Methods: The cohort consists of CAD patients, males ≤ 45 years old and females ≤ 55 years old. The participants are residents of Tehran or its suburbs and underwent coronary angiography between June 2004 and July 2011. A 10-year follow-up, via either clinical visits or telephone calls at least once a year, was commenced in August 2012. The end point is considered MACE, encompassing death, myocardial infarction, stroke, new coronary involvement, percutaneous coronary intervention, and coronary artery bypass grafting. Results: The cohort comprises 1232 eligible patients (613 [49.8%] males) at a mean age of 45.1 years (SD = 5.8). High frequencies of conventional risk factors, including hyperlipidemia (884 [71.8%]), hypertension (575 [46.7%]), positive family history (539 [43.8%]), cigarette smoking (479 [38.8%]), and diabetes mellitus (390 [31.7%]), were seen in the participants. The mean body mass index (BMI) of the enrolled patients was high (29.2 ± 4.8 kg/m2), and 532 (43.3%) and 440 (35.8%) of them were overweight and obese, respectively. The females’ BMI was higher (30.4 ± 5.3 vs. 28.0 ± 3.9 kg/m2; P < 0.001) and they had a greater mean abdominal circumference (99.9 ± 13.5 vs. 98.1 ± 9.3 cm; P = 0.035). Between August 2012 and August 2013, follow-up was successful in 1173 (95.2%) patients (median follow-up duration = 55.3 months, 95%CI: 53.5-57.0 months). Conclusion: Our younger patients with CAD had a high frequency of risk factors compared to the same-age general population and all-age CAD patients, which may predispose them to higher incidence of recurrent MACE.

Background: Postoperative cognitive dysfunction (POCD) has been an important complication of cardiac surgery over the years. Neurocognitive dysfunction can affect quality of life and lead to social, functional, emotional, and financial problems in the patient’s life. To reduce POCD, we sought to identify the association between cognitive dysfunction and perioperative factors in patients undergoing cardiac surgery. Methods: One hundred one patients aged between 45 and 75 years undergoing elective cardiac surgery were enrolled in this study. All the surgeries were performed on-pump by the same medical team. A brief Wechsler Memory Test (WMT) was administered before surgery, 3 to 5 days after the surgery, and 3 months after discharge. All related perioperative parameters were collected in order to study the effect of these parameters on the postoperative WMT scores and WMT score change. Results: The study population consisted of 101 patients, comprising 14 (13.8%) females and 87 (86.2%) males aged between 45 and 75 years. In univariate analysis, the baseline WMT score, serum levels of lactate dehydrogenase and T3, cross-clamp time, and preexistence of chronic obstructive pulmonary disease showed significant effects on the postoperative WMT score (p value < 0.05), whereas only the baseline WMT score and chronic obstructive pulmonary disease showed strong effects on the postoperative WMT score in the multiple regression model. In addition, the multiple regression model demonstrated a significant association between the baseline WMT score, serum creatinine level, and nitrate administration and the WMT score change. Conclusion: Our study showed that preexisting chronic obstructive pulmonary disease and preoperative high serum creatinine levels negatively affected cognitive function after surgery. In addition, there was a strong relationship between the patients’ basic cognition and POCD. Preoperative nitrate administration led to a significant improvement in POCD. It is also concluded that the preoperative administration of specific medicines like nitrates can reduce neurological complications after cardiac surgery.

Background: The incidence of stroke is 2.1-5.2% in bypass surgery patients with a mortality of 0-38%. This study was designed to evaluate the incidence of significant carotid artery stenosis and its related risk factors in candidates for coronary artery bypass graft (CABG) surgery. Methods: 1045 consecutive candidates for CABG underwent carotid artery Doppler examination in a prospective study. The relation of age, sex, smoking and diabetes as well as lipid profile and carotid stenosis was evaluated. . Results: In 1045 CABG candidates with the mean age of 60 years, the prevalence of significant carotid stenosis (>60%) was 6.9%. In the patients who aged 65 years and older, significant stenosis was12.5%. Age of 50 years and above, female gender, hypercholesterolemia and diabetes mellitus are independent risk factors for significant carotid stenosis. Conclusion: Significant carotid stenosis has an earlier beginning in our study. Cost effectiveness studies are recommended for revising the previous screening protocols.

INTRODUCTION: The use of coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB) or without CPB technique (off-pump) can be associated with different mortality and morbidity and their outcomes remain uncertain. The goal of this study was to evaluate the early outcome of on-pump versus off-pump CABG. METHODS: We conducted a retrospective database review of 13866 patients (13560 patients undergoing on-pump CABG and 306 patients undergoing off-pump CABG) at Tehran Heart Center between January 2002 and January 2007. We compared preoperative, operative, and postoperative characteristics between them. RESULTS: In-hospital mortality in the on-pump group was 0.8% compared to 0.7% in the off-pump group (P=0.999) and in-hospital morbidity was 11.7% and 6.5%, respectively (OR: 1.533, 95%CI: 0.902-2.605, P=0.114). Postoperative atrial fibrillation was more prevalent in on-pump versus off-pump surgery (6.0% vs 3.0%, P=0.028), however there were no statistical significant differences in other postoperative complications with regard to cardiac arrest (P=0.733), prolonged ventilation (P=0.363), brain stroke (P=0.999), renal failure (P=0.525), and postoperative bleeding (P=0.999). The mean length of stay in hospital (P=0.156) and in ICU (P=0.498) was also similar between the two groups. CONCLUSION: The results from an Iranian population-based study showed similar early mortality and morbidity of off-pump CABG in comparison to on-pump surgery.

Background: The aim of this study was to evaluate the impact of diabetes mellitus (DM) on peripheral vascular disease (PVD) in patients with coronary artery disease (CAD). Methods: A total of 13702 consecutive patients who underwent coronary artery bypass grafting (CABG) at Tehran Heart Center between January 2002 and March 2007 were included in this study. The demographic data, PVD, and outcome of these patients were reviewed. CABG patients before surgery were detected for PVD (stenosis ≥70% in the abdominal aorta; renal, carotid, and iliac arteries; or any other peripheral vascular system) with physical examination and past medical history. The suspected cases of PVD were, thereafter, confirmed via Doppler sonography or invasive angiography. Results: This study recruited 4344 diabetic patients (mean age 59.30±8.7 years) and 9358 non-diabetic patients (mean age 58.42±9.9 years). The diabetics were significantly older and had a higher incidence of PVD (2.7% vs. 1.8%), female gender, hypertension, renal failure, smoking, and dyslipidemia than the non-diabetics (P

Background: Dialysis patients frequently have coronary artery disease but are regarded as high risk patients for coronary artery bypass grafting (CABG). Methods: Between February 2002 and September 2006, seventeen dialysis-dependent patients underwent isolated CABG at our center. CABG was performed under cardiopulmonary bypass (CPB) for all the patients. All cases had been maintained on hemodialysis and the duration of preoperative hemodialysis ranged from 6 to 24 months (mean 13.4±6.4). The patients’ characteristics, clinical and operative data as well as perioperative and mid-term outcome were reviewed. Results: All patients were men with a mean age of 53±8.4 years. Mean preoperative ejection fraction was 45.5%±10.4% (range 25 to 60 %). One internal mammary graft was used in 16 (94.1%) patients. Cardiopulmonary bypass and aortic cross-clamp times were 71.3±18.7 and 40.5±8.3 minutes respectively. The more frequent complication was prolonged mechanical ventilation in 2 (11.7%), there was no perioperative mortality. In mid-term follow-up (mean time: 11.8±9.5 months) the mid-term mortality rate was 20% (3 patients). Conclusion: CABG in chronic renal dialysis patients can be accomplished with acceptable short and mid-term morbidity and mortality.

Background: We sought to evaluate the routine echo-Doppler screening of carotid artery stenosis in patients undergoing coronary artery bypass grafting. Methods: A total of 2179 consecutive patients who underwent coronary artery bypass grafting alone or with other cardiac surgery at Tehran Heart Center, Tehran-Iran, between January 2005 and January 2006 were included in this retrospective study. Carotid Doppler was performed for 1604 (81.48%) of these patients. Results: The patients’ age ranged between 20 and 84 years (mean: 58.33, SD: 10.08 years). Of the 1604 patients studied, 1186 (73.9%) were men, 592 (36.9%) had diabetes, 598 (37.3%) were smokers, and 194 (12.1%) cases had significant left main stenosis. Twenty-one (1.3%) patients had significant carotid stenosis (> 60% stenosis), which constituted 0.9% of all the bypass surgery candidates. Post-operative cerebrovascular accident was not detected in any of the patients with significant carotid stenosis, but cerebrovascular accident occurred in 22 (1.4%) of the patients without carotid stenosis. Magnetic resonance angiography (MRA) was conducted in 15 patients. In our univariate analysis, female gender (p value = 0.023), hypertension (p value = 0.055), peripheral vascular disease (p value < 0.001), and age (p value = 0.001) were significant in the development of carotid stenosis. Conclusion: Pre-operative duplex carotid screening seems to be necessary in patients when there is hypertension, peripheral vascular disease, female gender, and advanced age.

Background: Moderate non-organic tricuspid regurgitation (TR) concomitant with coronary artery disease is not uncommon. Whether or not TR improves after pure coronary artery bypass grafting (CABG), however, is unclear. The aim of this study was to evaluate the effect of isolated CABG on moderate non-organic TR. Methods: This study recruited 50 patients (40% female, mean age: 65.38±8.01 years, mean left ventricular ejection fraction (LVEF): 45.74±13.05%) with moderate non-organic TR who underwent isolated CABG. TR severity before and after CABG was compared. Pulmonary arterial systolic pressure (PAPs)>30mmHg and LVEF

Acinetobacter lwoffii, an important nosocomial pathogen, is a gram-negative aerobic bacillus that is a component of the normal flora on the skin, oropharynx, and perineum of about 20-25% of healthy individuals. We herein present a case of a 66-year-old man with combined mitral and aortic valve endocarditis associated with multi-drug resistance acinetobacter lowffii bacteremia.

Background: The aim of this study was to evaluate the impact of diabetes mellitus (DM) on peripheral vascular disease (PVD) in patients with coronary artery disease (CAD). Methods: A total of 13702 consecutive patients who underwent coronary artery bypass grafting (CABG) at Tehran Heart Center between January 2002 and March 2007 were included in this study. The demographic data, PVD, and outcome of these patients were reviewed. CABG patients before surgery were detected for PVD (stenosis ≥70% in the abdominal aorta; renal, carotid, and iliac arteries; or any other peripheral vascular system) with physical examination and past medical history. The suspected cases of PVD were, thereafter, confirmed via Doppler sonography or invasive angiography. Results: This study recruited 4344 diabetic patients (mean age 59.30±8.7 years) and 9358 non-diabetic patients (mean age 58.42±9.9 years). The diabetics were significantly older and had a higher incidence of PVD (2.7% vs. 1.8%), female gender, hypertension, renal failure, smoking, and dyslipidemia than the non-diabetics (P

Background: Discrete subaortic stenosis (DSS) is a progressive condition. Controversy still rumbles on as to whether the subaortic membrane causes aortic regurgitation (AR) and whether membrane resection reduces AR severity. We investigated the association between the left ventricular outflow tract peak gradient (LVOT-PG) and AR severity preoperatively and changes in AR severity and obstruction recurrence after surgery in DSS patients. Methods: Twenty patients were evaluated before and after surgery for DSS (mean follow-up time: 13.60±9.61 months). The patients were evaluated via transthoracic echocardiography and transesophageal echocardiography, if necessary. The cut-off point for surgery was LVOT-PG ≥50 mmHg or the presence of progressive AR. Results: The mean age of the patients was 28.55±15.23 years, and 35% of them were male. LVOT-PG decreased from a mean of 80.83±42.72 mmHg preoperatively to 19.14±14.03 mmHg postoperatively and to 25.47±16.10 at follow-up. AR was identified in 15 (75%) patients preoperatively: mild in 8 (40%) and moderate in 7 (35%). The postoperative change in AR severity was insignificant. The correlation between preoperative LVOT-PG and the incidence and severity of preoperative AR was not significant. AR severity had no correlation with age. Membrane recurrence occurred in 25% of the patients. Conclusion: Our results indicated no relationship between AR severity and LVOT-PG and the patient’s age. Patient selection for surgery can, therefore, be carried out on the basis of LVOT-PG or AR severity separately. Subaortic resection may reduce AR severity in some patients, but this reduction is not significant. Future studies are required to elucidate whether or not the presence of the AR is an indication for surgery.

Background: Prosthetic valve endocarditis (PVE) is an important cause of morbidity and mortality associated with heart valve replacement surgery. The aim of the present study was to describe the early outcome of treatment in patients with PVE in a single center. Methods: The data of all the episodes of PVE registered at our institution between 2002 and 2007 were collected and analyzed retrospectively. The patients were assessed using clinical criteria defined by Durack and colleagues (Duke criteria). The analysis included a detailed study of hospital records. The continuous variables were expressed as mean ± standard deviation, and the discrete variables were presented as percentages. Results: Thirteen patients with PVE were diagnosed and treated at our center during the study period. In all the cases, mechanical prostheses were utilized. The patients' mean age was 46.9±12.8 years. Women made up 53.8% of all the cases. Early PVE was detected in 6 (46.2%) patients, and late PVE occurred in 7 (53.8 %). Eleven (84.6%) patients were treated with intravenous antimicrobial therapy, and the other two (15.4%) required surgical removal and replacement of the infected prosthesis in addition to antibiotic therapy. Blood cultures became positive in 46.2% of the patients. Mortality rate was 15.4% (2 patients). Conclusion: It seems that in selected cases with PVE, i.e. in those who remain clinically stable and respond well to antimicrobial therapy, a cure could be achieved by antimicrobial treatment alone with acceptable morbidity and mortality risk.