Background: Postoperative atrial fibrillation (POAF) is the most common postoperative arrhythmia after coronary artery bypass graft (CABG) surgery. POAF is associated with an increased risk of stroke, discomfort, longer hospital stay with increased treatment costs. Aim: The aim of our study was to compare POAF prevalence after off-pump versus on-pump CABG. Materials and Methods: Our observational retrospective study included 152 patients, 121with on-pump CABG, and 31 with off-pump CABG. New-onset of POAF was observed, at the Clinic for Cardiovascular surgery, University Clinical Center Sarajevo, in the period from January 2017 to November 2017. Results: General demographics were similar. Occurrence of POAF was significant, developed in 35% of patients in on-pump CABG versus 13% of patients in off-pump CABG (p=0.013). In postoperative period there was significant difference in bleeding (p=0.0001), blood transfusion (p=0.007), vasopressor usage (p =0.003) and blood glucose level (p =0.002). There was a difference, but not significant, in low cardiac output, sepsis, need for hemodialysis and longer stay in intensive care unit. Conclusion: In our study we concluded that the off-pump CABG reduces the occurrence of POAF, which reduces post-operative complications thus shortening the length of stay in the ICU and reduces the costs of treatment.

Introduction: Most everyday activities, performed over a long period leads to performance degradation of skeletal muscles as well as spinal column which is reflected in the reduction of maximum force, reduction of the speed of response, reducing control of the movement etc. Although until now many mathematical models of muscles are developed, very small number takes into account the fatigue, and those models that take into account changes in the characteristics of muscles for extended activities, generally considered tiring under certain conditions. Given that the current models of muscle fatigue under arbitrary conditions of activation and load are very limited, this article presents a new model that includes scale of muscles overload. Material and Methods: There are three female cardiac surgeons working performing these surgeries in operating rooms, and their average anthropometric measures for this population is: a) Weight: 62 kg; b) Height: 166 cm. Age: 45 taken in the calculation within the CATIA software, that entity is entitled to 50% of healthy female population that is able to execute these and similar jobs. During the surgery is investigated the two most common positions: position “1” and “2”. We wish to emphasize that the experiment or surgical procedure lasted for two positions for five hours, with the position “1” lasted 0.5 hours, and position “2” lasted about 4.5 hours. The additional load arm during surgery is about 1.0 kg. Results: The analysis was done in three positions: “Operating position 1”, “Operating position 2 ‘, and each of these positions will be considered in its characteristic segments. These segments are: when the body takes the correct position, but is not yet burdened with external load, then when the surgeon receives the load and the third position when the load is lifted at the end of the position. Calculation of internal energy used on the joints is carried out in the context of software analysis of this model using CATIA R5v19. The proposed model is based on CATIA software model, which consists of visual indicators of the burden on certain parts of the body as well as the forces acting in these parts of the body. Conclusion: Based on these indicators to define which muscles, as well as that part of the skeletal system is overloaded, what is the position and what needs to be done that specific load be within permitted limits.

Objective: In our study we wanted to showed the safety, feasibility, efficacy and way how to solve the problems of endovascular repair for aortic dissection with insufficient proximal Landing Zone. Methods: The clinical data of all the patients with insufficient proximal Landing Zone (PLZ) for endovascular repair for aortic aneurism and dissection Stanford type B for the period from October 2013 to June 2014 was prospectively reviewed. According to the classification proposed by Mitchell et al, aortic Zone 0 was involved in 3 cases, Zone 1 in 1 case, Zone 2 in 9 cases and Zone 3 in 6 cases (19 patients in total). A hybrid surgical procedure of supraortic debranching and revascularization, with direct anastomosed truncus brachiocephalicus and left common carotid artery, were performed to obtain an adequate aortic PLZ. Revascularization of the left subclavian artery was carried out on the patient with dissection Stanford type B and short PLZ 2. Results: There was no significant difference of risk factors between Zone 0, Zone 1, and Zone 2 (Table 1.), but the length of the PLZ significantly differed between groups (p<0.01) and there is no significant difference in technical and clinical success rate among the groups. Conclusion: The procedure of extending insufficient PLZ for endovascular repair for aortic arch pathology is feasible and relatively safe. The TEVAR applicability in such aortic disorders could be extended.

ABSTRACT Objectives: The present study evaluates our experience with aorto-coronary bypass grafting in patients with severe dysfunction of left ventricle (LV) and low ejection fraction-EF(<35%). Revascularization of myocardium in this settings remains contraversial because of concerns over morbidity, mortality and quality of life. Material and Methodes: Forty patients with severe coronary artery disease and dysfunction of LV (low ejection fraction <35%) underwent coronary artery bypass grafting in period of 3 years. Preoperative diagnostic of 40 patients was consisted of anamnesis, clinical exam, non-invasive methods EHO, MR and invasive diagnostic methods-cateterization. The major indication for surgery was severe anginal pain, heart failure symptoms and low ejection fraction. Internal mammary artery was used in all operated patients. Results: Average age of patients who have been operated was 59,8. In the present study, 81,3% were male and 18,8% female. We found one-vessel disease present in 2,5% (1/40) of patients, two -vessel disease in 40% (16/40), three-vessel disease in 42,5% (17/40) and four -vessel disease in 15% (6/40) of patients. One bypass grafting we implanted in 2,5% patients, two bypasses in 42,5%, three bypasses in 45 5%, and four bypasses in 10% of patients. Left ventricular ejection fraction assessed preoperativly was 18%-27% and postoperatively was improved to 31, 08% in period of 30 days. Conclusion: In patients with left ventricular dysfunction, coronary artery bypass grafting can be performed safely with improvement in quality of life and in left ventricular ejection fraction.

INTRODUCTION Tight blood glucose control has become a therapeutical goal for anesthetic management for patients scheduled for cardiac surgery, especially if they are diabetic patients. AIM This study was created to confirm the benefits of intraoperative GIK solution usage during coronary bypass operation of diabetic patients. METHODS Patients with type 1 and 2 diabetes mellitus (DM) referred for coronary artery bypass grafting (CABG) were randomized to receive GIK solution (GIK--study group) in the first 24 hours intraoperatively or to receive official Clinical protocol without GIK solution (non GIK - control group). The primary clinical outcome was the cardiac index (CI) since it represents the most sensitive measure of cardiac work in the immediate postoperative period, and the secondary clinical outcomes were the glycemic control, insulin consumption, duration of mechanical ventilation (MV), potassium level and atrial fibrillation (AF) appearance. RESULTS One hundred diabetic patients, divided into two groups, were included in the study. The cardiac index did not show a significant difference, although the study group had CI with only minor variations than those of the controlled group, hence the reason we considered the study group as the more stable. The atrial fibrillation showed a difference between two groups, with 14 (28%) patients with postoperative AF in the control group compared with 3 (6%) patients with postoperative AF in the study group. As potassium values were stable in study group, we concluded that it can be one of the reasons for less postoperative AF in this group. The duration of MV showed a significant difference (0,003) between the two groups as well. In the study group the average MV time was 534,38 minutes, compared with the control group with 749,20 minutes. The average value of glucose was 11.1 mmol/l in the control group vs. 9.8 mmol/l in the study group. The study group had less insulin consumption in order to maintain target glycemia (p = 0.001). In the non GIK group average insulin consumption was 44 IJ per patient vs. 28.5 IJ in the GIK group. CONCLUSION Intraoperative GIK solution given to diabetic patients with CABG operation provides more stable CI, shorter time of MV, more stable values of potassium which provides normal rhythm and less AF onset, less insulin to maintain target glycemia. All the above mentioned provides more stable intraoperative hemodynamic and better recovery of diabetic

This study has been conducted in an effort to establish more suitable and accurate scoring model we use in everyday practice. Among the specific outcome prediction models, in 1989 Parsonnet et al elaborated a method of uniform risk stratification for evaluation of the results of cardiac surgery procedures. We have tested two forms of the Parsonnet score, Initial and Modified Parsonnet score, in our patients. In the first half of the year 2007, 145 patients were operated in Sarajevo Heart center. All operated patients in that period, have participated in this study. The overall hospital mortality was 4,13 (6 deaths). This study shows that the initial and modified Parsonnet's scores are predictive for operative mortality in adult cardiac surgery patients.

The main goal of our study was to evaluate possible perioperative risk factors for occurrence of atrial fibrillation in the postoperative period in patients after CABG operations. The study included 140 patients after CABG, divided into two groups - Group I - 64 patients with new onset of POAF and Group II - 76 patients without postoperative atrial fibrillation occurrence. In both groups possible risk factors for atrial fibrillation onset (preoperative and postoperative) were analyzed.Results showed that we can predict new onset of atrial fibrillation after CABG if the following preoperative factors are present - low ejection fraction (less than 40%), LAd > 40mm, higher body mass index (BMI over 30), presence of COPD and older age. Important perioperative factors for onset of atrial fibrillation in our study were longer extracorporeal circulation, increased dose/number of inotropic drugs, blood transfusion and elevated WBC count postoperatively.

Intensive care medicine is a relatively new specialty, which was created in the 1950's, after invent of mechanical ventilation, which allowed caring for critically ill patients who otherwise would have died. First created for treating mechanically ventilated patients, ICUs extended their scope and care to all patients with life threatening conditions. Over the years, intensive care medicine developed further and became a truly multidisciplinary speciality, encompassing patients from various fields of medicine and involving specialists from a range of base specialties, with additional (subspecialty) training in intensive care medicine. In Bosnia and Herzegovina, the founding of the society of intensive care medicine in 2006, the introduction of non invasive ventilation in 2007, and opening of a multidisciplinary ICUs in Banja Luka and Sarajevo heralded a new age of intensive care medicine. The number of admissions, high severity scores and needs for mechanical ventilation during the first several months in the medical ICU in Banja Luka confirmed the need of these kinds of units in the country. In spite of still suboptimal personnel training, creation of ICUs in Bosnia and Herzegovina may serve as example for other developing countries in the region. However, in order to achieve modern ICU standards and follow European trends toward harmonisation of medicine, Bosnia and Herzegovina needs to take up this challenge by recognizing intensive care medicine as a distinctive specialty, by implementing a specific training program and by setting up multidisciplinary ICUs in acute care hospitals.

Our aim was to evaluate risk stratification model, European System for Cardiac Risk Evaluation (logistic EuroSCORE) for patients treated in clinical hospital. EuroSCORE is useful to separate patients into risk groups so that the mortality and morbidity risk can be compared. From 1st January 2006 to 31st July 2006 the total of 124 adults have been operated and were classified according to the EuroSCORE algorithm. We have compared correlation of the predicted mortality and observed mortality (as death within the 30 days following the operation) and frequency of postoperative complications. All patients were divided into three risk groups. The low risk group had 30 patients with 0 death (0%) and 1 morbidity (3,33%). The medium risk group had 59 patients with 0 death (0%) and 4 morbidity (6,77%). The high risk group had 35 patients with 2 death (5,71%) and 5 morbidity (14,28%). Mortality in our clinic is much less than predicted mortality and we can be satisfied with our results. Incidence of complications after cardiac surgery is between 25 and 40% (STS database). Our results are within that range. We recommend logistic version of EuroSCORE as good and simple method to predict postoperative prognosis.

The tehniques of myocardial protection in cardiac surgery are innumerable. In this trial we tried to compare two established cardioplegic strategies in elective on-pump surgery (Intermittent antegrade warm blood cardioplegia--Calafiore--) and Kirsch-Solution with Haes). We took the data from our medical documentaton for 115 patients who underwent elective on-pump surgery in time period from February 2005 to July 2005.

ASA is commonly used for many years as pain relief drug, anti-inflammatory and against temperature, as well as antiaggregatory agent in coronary disease therapy. Aprotinin (Trasylol) has antifibrinolytic properties, among other actions, inhibits intrinsic coagulation cascade, and it has been demonstrated to reduce blood loss. Can be given in different doses and by different protocols. It is frequently used in cardiosurgery to reduce postoperative bleeding in the cases when ASA is not stopped at the right time before surgery. We evaluated the effects of therapeutic ASA doses on postoperative bleeding in patients undergoing coronary bypass grafting (CABG) compared with usage of Trasylol in CABG, bleeding and blood and fresh frozen plasma (FFP) requirements. This is a retrospective study, period October 1998-March 2002. Out of total CABG patients 75 fulfilled criteria (elective surgery, first CABG)--they were divided into following groups: ASA group of 25 patients (ASA withdrawn 1-3 days before surgery), Non ASA group of 25 patients (ASA withdrawn 10 or more days before surgery) and Trasylol group of 25 patients (ASA till surgery plus Trasylol intraoperatively). Average bleeding in ASA group 24 hours postoperatively was 1600 ml, Non ASA group had average bleeding 900 ml, while Trasylol group had average drainage of 700 ml after 24 hours. ASA average blood requirement was 1800 ml, 250 ml FFP and 250 ml 5% albumin, Non ASA group has less need for blood and FFP--250 ml blood, 50 ml FFP and 30 ml 5% albumin. Our Trasylol group had quite profound bleeding and high requirements for blood and FFP--average 850 ml blood, 200 ml FFP and 150 ml 5% albumin. We recommend discontinuation of ASA therapy sufficiently early for all elective CABG, because in our case Trasylol did not give satisfactory decrease in postoperative bleeding and blood and FFP requirements. That all increase possibility of postoperative complication occurrence and increase CABG costs.

Sildenafil has been registered for the treatment of erectile dysfunction since 1998. World wide a large number of patients were reported, dying of acute heart disease after using sildenafil. Therefore the patient instruction text was adapted. Simultaneous use of sildenafil and nitrates is contraindicated because of serious decrease of the blood pressure. The use of sildenafil can lead to physical stress in patients with a history of heart disease and a treadmill test assessment is advisable. In two years 38 adverse reactions were seen in 25 Dutch patients. The Dutch reports (three cardiovascular deaths since the introduction) also show the dilemmas in the assessment of the safety of sildenafil: is it the underlying disease or is it the drug that causes death? Further research into the adverse reactions has to be done, therefore reporting suspected side effects of sildenafil is important.