The aim of this study was to analyze the Transit time flow measurement (TTFM) experience in the first 1000 CABG operations. First 1000 patients had coronary artery bypass grafting (CABG) performed in Cardiovascular Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina, between September, 1998 and September, 2003. CABG without use of cardiopulmonary bypass (CPB)-(OPCAB) was used as the preferential surgical method both because this method is reported to have equal or better results than CABG with use of CPB (ONCAB), and because of the significant cost savings realized. TTFM was routinely used in all grafts as a quality assurance measure. Criteria for a poor functioning graft were: low mean flow (MF), pulsatility index (PI) above 5 and a poor diastolic flow pattern. When no reversible cause of poor TTFM results were identified the graft was revised. A total of 1394 grafts in OPCAB group and 1478 in ONCAB group were performed. A total of 38 grafts (2,72%) in 37 patients (7,07%) were revised in OPCAB group, and 26 grafts (1,75%) in 26 patients (5,45%) in ONCAB group. 1 patient in OPCAB group needed 2 graft revisions. Graft revisions were more common in OPCAB, but with no significant difference (p=0,1035). The most frequently revised graft was LAD graft in both groups. Although the percentage of grafts revised are relatively low, it is still very important to record TTFM. More than 5% of patients in both groups needed graft revision. Although TTFM does not guarantee that grafts will stay open for a prolonged period of time we certainly believe that grafts that are occluded at the time of surgery will continue to stay occluded. TTFM is especially critical in OPCAB surgery where the technical challenge of grafting is higher then in ONCAB.

Angiotensin converting enzyme (ACE) and nitric oxide (NO) have been suggested to be in - The objective of this study is to compare outcomes of coronary artery bypass grafting (CABG) in high-risk patients performed with- (ONCAB) and without -(OPCAB) use of cardiopulmonary bypass. From October 2001 till October 2005, 210 high-risk patients classified according to European System for Cardiac Operative Risk Evaluation (EuroSCORE) (score =or> 5) underwent CABG in Cardiovascular Clinic, University Clinical Centre Tuzla, Bosnia and Herzegovina. 138 patients operated as OPCAB were compared to 72 patients operated as ONCAB. All data were entered in a patient database (DATACOR) and analyzed in SPSS. OPCAB patients received insignificantly less number of grafts than those treated by ONCAB (3,0 vs. 3,2) (p=0,071). Stroke was significantly more common in ONCAB group (2,9 vs. 11,1%) (p=0,034) while the incidence of other postoperative complications and mortality were similar. The ventilation time (4,3 vs. 6,7 hours) (p=0,007), retransfusion volume (392,7 vs. 633,7 ml) (p=0,041) and hospital stay (8,2 vs. 10,1 days) (p=0,031) was significantly less in OPCAB group. OPCAB is safe and effective in treatment of high-risk patients. Avoidance of cardiopulmonary bypass is associated with reduced incidence of neurologic complications, lower intubation time, retransfusion rate and shorter hospital stay, and in our experience the preferred operative method in such patients.

Patients with significant stenosis (>50%) of the left main coronary artery (LM) are considered high risk for coronary artery bypass grafting (CABG). LM disease is mainly considered a relative contraindication for off pump coronary artery bypass grafting (OPCAB) because of the reduced tolerancy of hamodynamic disturbances which occurs during mobilisation and exposition of the heart, necessary for this type of operations. The aim of the study is to show feasibility of OPCAB for patient with occlusion of the LM and 75% stenosis of the right coronary artery. Operation was carried out through median sternotomy, LIMA stitch was used for the exposure, CTS stabilisator was used for local myocardial stabilisation, intracoronary shunt was inserted intraluminary. Three aortocoronary bypasses were created, operation passed without any hamodynamic instability. Main peri and postoperative results: total length of the operation: 265 min; time on respirator: 1 hour; total blood drainage on chest tubes: 532 ml; transfused blood: 0 ml; time in the intensive care unit: 1 day; total hospitalisation time: 7 days. This case review suggest that OPCAB is feasible and safe in the treatment of patients with LM occlusion and significant stenosis of RCA.

The retrospective study included 250 patients, treated at Clinic for cardiovascular diseases of Tuzla Clinical center, between 30.08.2003. and 15.11.2004. In the coronary disease group there were 145 men, 55 women, with diagnosed coronary artery stenosis of 50% or more. The control group had 150 patients, 35 men and 15 women, medium age of 58.2. The control group had coronary artery stenosis of 50% or less. Coronarography was done using AXIOM ARTIS DFC (SIEMENS). Lipoproteins were determined on the Clinic for biochemistry of Tuzla Clinical Center using automatic analyser DIMENSION LxR (DADE BOEHRING). In the coronary artery disease (CAD) group elevated triglycerides were found in 38.5%, total cholesterol in 88% and LDL 55.5% of patients. The concentration of HDL cholesterol was elevated in 52.5% of patients. In the control group elevated values of triglycerides were found in 28%, total cholesterol 46%, LDL cholesterol 16%, and lower values of HDL in 10% of patients. Statistically significant differences of lipide profile of CAD patients in relation to the control group was defined. Using regresional analysis it was established that decide elevated values of total and LDL cholesterol, low values of HDL were also significant.

METHODS There have been 784 coronary artery bypass grafting (CABG) procedures performed at a new center for treating cardiovascular disease in Tuzla, Bosnia and Herzegovina, and the surgical team has been fully trained in offpump coronary artery bypass (OPCAB) surgery. All surgical patients were considered for on-pump CABG (ONCAB) and OPCAB surgical procedures. Minimally invasive direct coronary artery bypass grafting and robotic procedures were done as OPCAB. For multivessel median sternotomy cases, the selection criteria were arbitrary (approximately 50% were performed as ONCAB for perfusionist training). Patients who were scheduled for and began their operations as OPCAB but who were then placed on cardiopulmonary bypass during the surgical procedure were counted as conversions. The outcomes of converted patients were studied and are the subject of this report. RESULTS Of the 784 CABG procedures, 391 (49.6%) were scheduled and performed as ONCAB operations; 357 (45.5%) were performed as OPCAB; and 36 (9.2% of the originally scheduled OPCAB patients or 4.6% of the total number of CABG surgeries) were originally scheduled as OPCAB operations but were converted to ONCAB. Reasons for conversions were hemodynamic instability (21 patients), difficult revision of grafts (8), ventricular fibrillation (5), and poor native vessel (2). Outcomes of patients undergoing conversions were analyzed with respect to the conversion cause. When the cause of the conversion was mild-to-moderate hemodynamic instability or difficult graft revision (n = 27), no adverse ischemic effects were seen; however, when the cause of conversion was severe hemodynamic instability, ventricular fibrillation, or cardiac arrest (n = 9), 6 patients (66.6%) had severe ischemic complications involving the central nervous system or the myocardium. DISCUSSION Myocardial ischemia must be monitored and treated aggressively in OPCAB surgery. In patients with mild hemodynamic instability, conversion did not adversely affect outcome. In patients with severe hemodynamic compromise and cardiac arrest, serious complications of cerebral and myocardial ischemia were observed. The appropriate timing of conversion is essential.

The objectives of the study were to identify possible associated respiratory risk factors and to assess incidence of overall postoperative complications after the lung resection. We reviewed 110 patients who underwent lung resections due to malignant neoplasms or benign lung diseases. The risk of postoperative complications was evaluated using the univariate analysis. Results confirmed that low FEV1, postoperative high PaCO2, ASA-status and advanced age were factors associated with development of postoperative complications.

In the LBBB (the block of the left branch) control group there were 2 examinees Hi (6.45%). LAH and LHP were not found. The block of the left branch often creates problems in electrocardiographic diagnosis of coronary disease. It can be registered as complete LBBB, anterior-left hemiblock (LAH) and posterior-left hemiblock (LPH). The combinations are possible with the block of the right branch (RBBB) and A-V blocks. The most frequent cause is coronary disease, and next is sclerodegenerative changes in heart intrinsic-conduction system. Our study involves 98 of examinees with coronary disease, and 78 of that number are males and 24 are females, all average-aged 60.83+/-12.6. Control group (examinees who do not suffer from coronary disease) is made of 31 subjects, and 24 of that number are males, and 7 are females, all average-aged 57.16+/-10.4. Those diagnosed with coronary disease, as the examinees from control group, had the indications for the coronagraphy. The coronagraphy was performed and electrocardiographic findings were analyzed. The average degree of coronary arteries stenosis of the ill examinees was 77.5+/-14.9%, and in the examined group 23.5+/-12.5%. Of the examinees with the block of the left branch, 4 Hi examinees had one-artery illness (4.08%), 3 Hi had two-artery illness (3.06%) and 1 Hi had three-artery illness (1.02%). In one-artery coronary disease LAD stenosis was most frequent. Disruptions in conduction LBBB+LAH was found in 17.34% ill examinees, and 8.16% of those from LBBB and 9.8% from LHH. Of examinees with LAH, one-vessel coronary disease was found in 5.1% and two-vessel coronary disease in 4.08%. The most frequent was LAD stenosis, rarely combined with CX stenosis, and in one case LAD combined with RCA stenosis. In group with coronary disease LPH was not found.

The objectives of the study were to identify possible associated respiratory risk factors and to assess incidence of overall postoperative complications after lung resection. We reviewed 110 patients undergoing lung resections because of malignant neoplasms or benign lung diseases. The risk of postoperative complications was evaluated using unuvariate analysis. Results confirmed that low FEV1, postoperative high PaCO2, ASA-status and advanced age were factors associated with development of postoperative complications.

This study reviewed the early experience with off-pump coronary artery bypass surgery in treatment of patients with severe left main coronary artery stenosis. From May 2002-December 2003, 75 patients with significant left main coronary artery stenosis (> or = 50%) underwent coronary artery bypass grafting. 35 patients were operated without the use of cardiopulmonary bypass (OPCAB) and compared with 40 patients operated with the use of cardiopulmonary bypass (ONCAB). Mean age, ejection fraction and EUROSCORE were similar in both groups. Average grafts per patients was also similar (OPCAB 3.0 vs. ONCAB 3.2). The incubation time (3.1 vs. 5.8 hours), blood loss (445 vs. 610 ml) and hospital stay (6.8 vs. 8.1 days) were less in OPCAB group. There was no mortality in OPCAB group whereas 2 patients (5.0%) died in ONCAB group. Our early experience suggests that off-pump coronary artery bypass surgery is effective in treatment of patient with severe left main coronary artery stenosis and has advantages compare to operations with the use of cardiopulmonary bypass.

Atrial fibrillation characterized by uncoordinated atrial activation. On the electrocardiogram is described by the replacement of consistent P waves by rapid oscillations or fibrillatory waves that vary in size and shape. The incidence of atrial fibrillation in patients under 22 years old is 2%, whereas for patients under 60 years old, the incidence is 8.8%. The most common cause of death in patient with atrial fibrillation is stroke, and occurs in 1% to 5% patients in the age group 50 to 59 years, whereas 30% patients in the age group 80 to 89 years. The incidence of atrial fibrillation after coronary artery bypass surgery occurs in 20% to 40% patients. We examined the incidence atrial fibrillation in patients after coronary artery bypass surgery, most common risk factors for occurs atrial fibrillation. Prospective study was conducted on 100 patients, who were divided in two groups, which had similar age structure, gender and they had disease coronary artery which required coronary artery bypass surgery. We established that incidence atrial fibrillation after coronary artery bypass surgery was 24%. Age was one of main risk factors that is responsible for appearance of atrial fibrillation. Gender like risk factor at 60 year old persons does not have statistical significance, while at persons which are younger then 60 years male has greater statistical significance like risk factor. Patients with triple vessel disease after coronary artery bypass surgery had most common atrial fibrillation.