Objective Postoperative respiratory complications (PRCs) are a significant concern after cardiac surgery, contributing to increased morbidity and mortality. This study aimed to analyze the incidence and risk factors for PRCs in a tertiary center in Bosnia and Herzegovina and compare findings with data from developed countries. Material and Methods This prospective cohort study included 300 adult patients who underwent open-heart surgery with cardiopulmonary bypass at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, between January 2020 and October 2023. Preoperative, intraoperative, and postoperative variables were analyzed, including comorbidities, surgical procedures, mechanical ventilation duration, and intensive care unit stay. PRCs were defined based on standardized clinical and radiological criteria. Multivariate logistic regression identified independent risk factors. Results The most common PRCs were pneumonia (37.3%), atelectasis (29.3%), pleural effusion (22.0%), and respiratory failure (10.7%). Key independent risk factors included oxygen saturation <94%, ejection fraction <45%, diabetes mellitus, anemia, and red blood cell transfusion >500 mL. In contrast to studies from developed countries, intraoperative variables were not significant predictors. Conclusion Our findings suggest that preoperative comorbidities play a more dominant role in PRC development in our setting compared to developed nations. The high incidence of pneumonia may reflect delayed postoperative mobilization and limited access to respiratory therapy. These results underscore the need for optimized preoperative patient management and improved postoperative respiratory care protocols in resource-limited healthcare settings.

Aim To assess whether colorectal carcinoma (CRC) survivors 5 years post-fluoropyrimidine (5-fluorouracil and capecitabine) chemotherapy (ChemT) have increased presence of subclinical coronary artery disease (CAD), lower iron and altered blood cell composition. Methods This prospective, 2 year, single-center study used invasive coronary angiography to detect the presence of CAD among ChemT (N=45) and control group patients (age, gender-matched, cancer-naïve (N=45). Full blood count and iron levels were compared between two groups. Results Coronary angiography in 90 patients (mean age 65±7 years; 60% male) identified significantly higher presence of CAD in CRC ChemT patient group compared to control: 80% vs. 55 % (p=0.013). CRC ChemT patients had lower red blood cell count (4.45± 0.56 vs. 4.68± 0.50 x109/L; p=0.044), platelet count (214.18±50.99 vs. 251.00 ±156.40 x109/L; p=0.002) and white blood cell count (5.50 ±1.62 vs. 7.67±1.72 x109/L; p=0.000). Mean corpuscular hemoglobin concentration was higher in CRC ChemT patients (342.11 g/L ±15.74 vs. 336.42 g/L ±10.29: p=0.046), and iron deficiency was more prevalent (ChemT20.40 µmol/L ±3.891vs. control 23.37 µmol/L ±4.10: p=0.001). Conclusion Our study shows that among CRC survivors who underwent 5-FU and capecitabine therapy there is a significantly higher prevalence of CAD accompanied by long-term impairment in blood erythropoiesis. Keywords: coronary artery disease, coronary angiography, erythropoiesis.

AIM This study aims to identify independent risk factors associated with postoperative respiratory complications (PRC) in patients undergoing coronary artery bypass surgery (CABG). METHODS A retrospective cohort study was conducted on 98 patients (82 male, 16 female) who underwent CABG at the Cardiovascular Surgery Clinic, University Hospital Tuzla. The incidence of PRC and potential risk factors were analyzed. Univariate analysis was performed to assess associations, followed by multivariable logistic regression to adjust for confounding factors. Independent risk factors were identified, including diabetes mellitus, smoking, hypertension, gender, and preoperative oxygen saturation <94%. RESULTS PRC were observed in 48 patients (48.97%). Preoperative factors significantly associated with PRC included diabetes mellitus, smoking, hypertension, and low preoperative oxygen saturation. Intraoperative and postoperative factors, such as prolonged surgery duration (>180 min), mechanical ventilation >120 min, and blood transfusion exceeding 500 ml/24 h, were also identified as risk factors. Multivariable logistic regression confirmed that prolonged surgery duration, extended respiratory support, and transfusions >500 ml/24 h were independent predictors of PRC. CONCLUSION This study highlights the importance of perioperative risk stratification in preventing PRC. Reducing prolonged mechanical ventilation and minimizing unnecessary transfusions may improve postoperative outcomes. Further studies with larger cohorts are needed to refine risk prediction models and optimize perioperative management strategies.

Background: Relationship between preoperative anemia (PA) and postoperative delirium (POD) is not still completely clear and totally proven for surcigally treated patients. This study tries to unveil that connection in patient surgically treated for colorectal cancer (CRC). Objective: The aim of this study is to examine relationship between PA and POD in patients surgically treated for CRC and improve preoperative preparation and recognition of critical risk groups of patients for POD. Methods: Out of 62 patient were analysed in prospective method. All patient have been operated for CRC in Surgical clinic of University clinical centre Tuzla from june until december of 2024. Patients were divided in 2 groups depending on presence of PA. Presence of PA is defined as blood hemoglobin concentration (HGB) lower than 130 g/L (<13 g/dL) or hematocrite (HCT) lower than 39% in grown up men and HGB <120 g/L (<12 g/dL) or HCT<37% in grown up women. Incidence of POD was observed and noted postoperatively. POD was diagnosed and confirmed with CAM test (Confusion Assessment Method), which was done inside first 2 hours after surgery and patient extubation. Noted datas were analysed with descriptive and analytic statistic methods. Results: POD incidence was 27% (17/62) on the first postoperative day. After analysis statitically significant realtionship was found between PA and POD (ρ=0.324; p<0.05). Realised corellation is on the significance level of 0.05 (95%), it has positive direction and waek intensity. POD occurs 4,5 times more often in patients with PA. (OR= 4,500; 95% IP: 1.355–14.944). Conclusion: PA is connected with increased number of patients with POD who have been surgically treated for CRC. PA can be defined as one important preoperative risk factor that affect onset of POD . Identification of all preoperative risk factors and its correction represent best way of POD prevention.

Background: The upper mini sternotomy Bentall (mini-Bentall) procedure may result in less trauma and earlier recovery compared with the usual full sternotomy Bentall procedure (Usual Bentall-DeBono procedure). Objective: This study evaluates the efficacy and safety of mini sternotomy aortic root surgery (MSARS), a minimally invasive technique designed to reduce surgical trauma, improve postoperative recovery, and lower healthcare costs. Methods: The upper mini sternotomy (UMS) approach was performed in ten patients focusing on standardized surgical procedures, and rigorous postoperative care. Key findings indicate that MSARS markedly reduces postoperative complications, ICU stay, and overall hospital stay compared to traditional sternotomy. Results: The median postoperative length of stay was seven days for MSARS versus 11 days for traditional sternotomy, with ICU stays of 27 hours and 105 hours, respectively. Our study also highlights the cost-effectiveness of MSARS, with decreased hospital costs per patient due to reduced ICU resource utilization and shorter hospital stays. These findings suggest that MSARS is a valuable and advantageous alternative to traditional sternotomy, offering substantial benefits in terms of patient outcomes and healthcare efficiency. Conclusion: Mini sternotomy aortic root surgery via partial upper sternotomy could be a safe alternative to the full median sternotomy, marking a significant advancement in the field of cardiac surgery.

Background: Video-assisted thoracic surgery (VATS) for both minor and major thoracic procedures has become routine practice worldwide. In this study, we present our experience with multiportal and uniportal VATS (MVATS and UVATS) in Bosnia and Herzegovina (B&H). MVATS and UVATS procedures were performed in two B&H Clinical Centers: Tuzla and Sarajevo. The first MVATS procedure at Tuzla Clinical Center was conducted in 2004, and the first UVATS lobectomy was performed in 2019. At Sarajevo Clinical Center, the initial MVATS took place in 2005, and the first UVATS lobectomy was carried out in 2020. Methods: We retrospectively analyzed 401 VATS procedures with prospective data, collected between 06/2017 and 04/2023. The VATS technique was employed for wedge resections, partial resections, lobectomies, and other types of resections, including metastasectomy. Results: Out of the 401 patients, 242 (60.34%) were male, and 159 (39.66%) were female, with a mean age of 57.2±23 years. The procedures consisted of 231 UVATS and 170 MVATS. Lobectomy was performed in 61 (15.21%) cases, wedge resections in 216 (51.37%), partial resections in 85 (21.19%), and other types of resections in 39 (9.72%) patients. The median duration of the procedure was 210 minutes for lobectomy, and 77.5 minutes for wedge and other types of resections. Major complications, such as bronchopleural fistula in 22 (5.49%) cases, wound infections in 20 (4.99%), atelectasis in 19 (4.74%), lung infiltrations in 15 (3.74%), and bleeding in 15 (3.74%) patients, were observed. The overall mean hospital stay for all procedures was 6.45 days. Conclusion: Uniportal and multiportal VATS techniques are feasible and safe for various indications in thoracic surgery. VATS can be performed in middle-income countries such as Bosnia and Herzegovina with acceptable results, by thoracic surgeons experienced in general thoracic surgery

Aim To determine risk factors responsible for developing postoperative complications after the thoracic aorta reconstructive surgery. Methods Medical records of 100 patients, who had undergone elective or emergency thoracic aorta reconstructive surgery at the Clinic for Cardiovascular Surgery, University Clinical Center Tuzla, were analysed. Intraoperative data as cross-clamp time (CCT), duration of cardiopulmonary bypass (CPBT) and hypothermic circulatory arrest time (HCAT) were evaluated. Univariate analysis was used to show risk factors for developing postoperative cardiac, respiratory, surgical and renal complications. Results Between May 2019 and April 2021, 48 Bentall procedures (BP), 23 ascending aortic replacements (AAR), 20 BP and coronary artery bypass grafting (CABG) and 9 aortic valve replacements (AVR) with AAR were performed. Incidence of postoperative complications in the elective and emergency groups was as follows: respiratory 20% vs 38% (p=0.049), cardiac 18% vs 70% (p=0.015), renal 16% vs 48% (p=0.027) and surgical 4% vs 6% (p>0.05). Intrahospital 30 days morbidity was 44% with mortality rate of 13%. The results showed that CPBT>180 minutes was a risk factor for respiratory (p=0.034), cardiac (p=0.020) and renal (p=0.027) postoperative complications after acute type A aortic dissection surgery. Conclusion CPBT > 180 min is a risk factor for postoperative development of respiratory, cardiac and renal complications. Postoperative cardiac and renal complications were associated with longer HCAT.

Aim To determine the prevalence of new-onset atrial fibrillation (NOAF) following percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) for left main coronary artery disease (LMCAD) and its effect on 6-month cardiovascular outcomes. Methods This prospective study included 40 patients diagnosed with LMCAD, in the period from 2017 to 2018. The patients with LMCAD and low or intermediate SYNTAX score were randomized to PCI with zotarolimus-eluting stents versus CABG. Outcomes were analyzed according to the development of NOAF during the initial hospitalization following revascularization. Results Among 40 patients without atrial fibrillation on presentation, NOAF developed 3.1±1.3 days during hospitalization in three CABG treated patients, and one PCI treated patient. One patient that was CABG treated developed NOAF after two months. Patients with versus patients without NOAF had a significantly longer duration of hospitalization, probably because they were discharged on anticoagulant therapy. Myocardial infarction was presented in one CABG treated patient after 3 months, and also in one PCI treated patient after 4 months. One patient died 2 months after the operation, and one developed stroke 5 months after the CABG operation. Conclusion The NOAF was common after CABG, but extremely rare after PCI, and it occurred almost exclusively following CABG. There was a clear statistical tendency for all-cause death, cardiovascular death and stroke at 6-month follow-up period.

Introduction: Percutaneous transluminal angioplasty (PTA) is one of the treatment options for stenotic and obstructive lesions of the subclavian artery. Aim: To evaluate initial and long-term results of percutaneous transluminal angioplasty of subclavian artery lesions. Methods: During period February 2016 to December 2017, 26 patients (12 men and 14 women) with significant subclavian artery stenosis and occlusion were admitted and underwent PTA. All patients were symptomatic. All PTA procedures were performed with the patient under local anesthesia, through the femoral artery (n=22), brachial artery (n=4), or combined route (n=6). In 7 patients, we performed direct stenting, while in the other 15 patients we performed predilatation before stent implantation. The follow-up protocol consisted of regular clinical examinations in 1, 3, 6 and 12 months post-procedural, and annually thereafter with duplex ultrasound monitoring. Results: Initial technical success was achieved in 22 of 26 procedures (84.61%), 100% in stenotic lesions and 55.5 % in total occlusions. Fourth of nine occlusions could not be recanalized by PTA. These patients were managed surgically. The 30-day mortality rate was 0% for the entire group. No patients required reintervention for recurrence of symptoms and the stents remain patent at period of 12 months post-procedural. Conclusion: The minimal invasive technique, the markedly lower complication rate, the high long-term patency, patient’s comfort and the decreased hospital stay have made endovascular repair the primary choice of treatment in the majority of cases, especially in patients with stenotic lesions and high-risk patients. We consider PTA of subclavian artery stenotic/obstructive lesions should be the first therapeutic option.

Introduction: Cardiovascular complications in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. Aim: The aim of study is to show the incidence and type cardiac complications after traumatic and spontaneous SAH. Patients and methods: The study had prospective character in which included 104 patients, with diagnosed subarachnoid hemorrhage (SAH), in the period from 2014 to 2017. Two groups of patients were formed. Group I: patients with SAH caused by the rupture of a brain aneurysm. Group II: patients with SAH after traumatic brain injury. Results: Electrocardiogram (ECG) abnormalities was predominant after traumatic brain injury 74 %, with statistically significant difference atrial fibrillation 42.5 % (p = 0.043) and sinus bradycardia 31.4 % (p = 0.05). Hypertension are predominant in patients with spontaneous SAH with statistically significant difference (15 (27.7%) vs 36 (72%) p=0.034) and hypotension in group II (10 (18.5%) vs 2 (4%) p = 0.021 ) with traumatic SAH patients. The time in Intensive Care Unit (ICU) for traumatic SAH group was 6.1 ± 5.2 days and 3.9 ± 1.16 for spontaneous SAH group with statistical significance (p = 0.046). Respiratory support time was longer in traumatic SAH group (39.4 ± 23.44 vs. 15.66 ± 22.78) with p = 0.043. Conclusion: Cardiac dysfunction in patients with subarachnoid hemorrhage are considered to be a neurally mediated process rather than a manifestation of coronary artery disease. Early treatment of cerebral injury could be reduce incidence of cardiac complications after traumatic brain injury. Cardiac dysfunction in patients with SAH is still very high, despite substantial qualitative progress in their treatment.