Background Postoperative bleeding in patients who underwent elective coronary artery bypass surgery (CABG) may increase due to preoperative anticoagulant therapy indicative of their disease - acute coronary syndrome or implanted coronary artery stent. Increased bleeding in many cases requires the use of blood and blood derivatives, and sometimes even reoperation. Their use poses the risk of complications, may extend the hospitalization. Methods Our observation retrospective study included 131 patients, 41 treated with aspirin and 90 treated with aspirin and clopidogrel. All underwent for the first time elective on-pump isolated CABG surgery at Clinic for cardiovascular surgery of Clinical Center University of Sarajevo, in period June 2016 to September 2017. The data were collected from patient’s records. Results Out of 131 patients,73.3% were male. The average age was 62. The average total drainage during the first 48 postoperative hours in ASA group was 1027.4±404.9ml and 1049.8±371.3ml in DAPT group. The mean number of whole blood transfusions in the DAPT group washigher compared to ASAgroup. The average number of fresh frozen plasma were higher in the DAPT group 0.84±0.51 compared to the group ASA 0.39±0.07, as well the average thrombocytes transfusions were slightly higher in the DAPT group. Statistical analysis suggests that there is no significant difference between the observed groups (p>0.05). Also, our study did not show a statistically significant difference between arrhythmia onset, the length of mechanical ventilation, use of protamineand tranexamic acid. Reoperation due to postoperative bleeding was recorded in 2 cases in the DAPT group as well as 2 lethal cases. Conclusion In our study, we could not demonstrate less postoperative bleeding and use of blood and blood products in a group of patients who were preoperatively treated with aspirin compared to patients with dual antiplatelet therapy in the elective isolated CABG surgery.

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 Excess dilatation of the left atrium >65 mm is known in the literature as gigantic atrium. This dilation is most commonly encountered in the mitral insufficiency of rheumatic etiology, but also in severe prolapses of the mitral valve, permanent atrial fibrillation, and at the left right shunt with cardiac insufficiency. Case report In this paper is presented a case study of echocardiographically verified giant thrombus in left atrium in a 50 years old female patient aged 50 hospitalized because of tiredness, choking, heartburn and urinary tract symptoms. The patient had rheumatic fever at age of 18 years. At age of 35, she was diagnosed with mitral stenosis. In permanent atrial fibrillation with anamnestic data on the previous cerebrovascular stroke (CVI) and the repeated transitional ischemic seizures. Echocardiographic examination confirmed severe mitral stenosis with moderate aortic insufficiency and gigantic left atrium (LA) with gigantic thrombus. Invasive diagnostics were indicated and performed, followed by an acute cardiac surgery including left atrial thrombectomy and implantation of the mechanical aortic and mitral valve. The surgical course was without complications. Conclusion On eleven postoperative day, after mobilization, the patient experiences stroke with motor aphasia. She was clinically recovering from stroke consequences, and remains cardiollogically stable.

Patients with cancer in developing and low-income countries have limited access to targeted cancer therapies. The transitional nature of these economieshas influencedhealthcare funding,whichhas resulted in the unavailability of targeted cancer treatments. Besides the three studies that will be described here, to our knowledge, no literature exists on the clinical outcome of patients treated with delayed targeted cancer therapy. To raise awareness on the importance of timely targeted cancer treatment, we will discuss three key issues: (1) the low number of targeted cancer therapies for different cancers, (2) thedelay incancer treatment, and (3) the unavailability of cancer diagnostics.

1Travnik General Hospital, Travnik, Bosnia and Herzegovina 2Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina KeYWORdS: patent foramen ovale, management. citAtiON: Cardiol Croat. 2019;14(3-4):92-3. | https://doi.org/10.15836/ccar2019.92 *AddReSS FOR cORReSPONdeNce: Alma Sijamija, J.U. Bolnica Travnik, Kalibunar bb, 72270 Travnik, Bosna and Herzegovina. / Phone: +387-61-780-085 / E-mail: alma.sijamija@hotmail.com ORcid: Alma Sijamija, http://orcid.org/0000-0003-2818-0501 • Nermir Granov, http://orcid.org/0000-0002-6228-6230 Alma Agačević, http://orcid.org/0000-0003-4671-0991 • Omer Perva, http://orcid.org/0000-0003-2645-1558 Nedžad Hadžić, http://orcid.org/0000-0002-7186-7803

Aim: The aim of this study was to examine the impact of antibiotic consumption on development of antimicrobial resistance in Acinetobacter baumannii. Material and Methods: The study was conducted in University Clinical Center of Sarajevo. In our retrospective study Acinetobacter baumannii isolated in period from July 1st 2009 to December 31st 2012. Isolates were detected from different clinical samples including urine, wound swab, blood, bronchial aspirate and other samples which were collected from patients situated on various hospital wards. Clinical isolates belonged to one per patient in a given period of time. Results: Antimicrobial resistance was interpreted according to CLSI breakpoints. Consumption of antibiotics was analyzed according to recommendations of the ESAC-Net and current Acinetobacter baumannii classification. Pearson’s correlation showed a positive correlation between gentamicin consumption and emerging of resistance (p = 0.023). Conclusion: Increase in the antimicrobial use was followed with an increase in resistance of Acinetobacter baumannii isolates. Monitoring of antibiotic resistance and consumption is of a great importance in order to reduce the emergence and spread of antimicrobial resistant organisms in the health care settings.

1Travnik General Hospital, Travnik, Bosnia and Herzegovina 2Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina

Aim: This study sought to assess whether the volume and osmolarity of contrast media (CM) influences the occurrence of contrast induced nephropathy (CIN) following coronarography procedure. CIN can be defined as an increase in the serum concentration of creatinine greater than a 25% from baseline during the period of 12 to 48 hours after the administration of radiocontrast media. Material and methods: We examined 100 patients without diabetes with serum creatinine concentration from 45 mmol/l to 141 mmol/l and 100 patients with diabetes with serum creatinine concentration from 46 mmol/l to 161 mmol/l who underwent coronary angiography. During procedure they received iso-osmolar contrast medium, Visipaque 320 (iodixanol-320), for group without diabetes from 40 to 340 ml and for group with diabetes from 49 to 310 ml. Results: CIN occurred in 27 (13,5%) of the 200 study patients. There was a trend toward higher prevalence of CIN (16% vs.11%, p = 0.086) in the diabetic group compared with the non-diabetic group. Patient with diabetes received less contrast media, they are younger but number patients with CIN are higher. Conclusion: Increasing contrast media dose is associated with the occurrence of CIN following coronarography. But, another risk factors like diabetes mellitus, old age, male sex and preexisting kidney disease have influence of developing CIN after coronarography.

IntroductIon: Cardiac tumors can be primary (benign or malignant), with incidence from 0.002 to 0.3% according to autopsy reports, and secondary which are more common, found in about 5-10%. The most common primary tumor of the heart is the myxoma. About 75% of all myxomas are located in the left atrium. They occur in all age groups, usually from the third to the sixth decade. They are more common in women, usually solitary, round tumors with a diameter of 10 cm, uneven surfaces.

As patients and their physicians become more demanding, the desire to make the procedures "minimally invasive" is growing constantly. In short, "minimally invasive" is a code phrase for life saving procedures which in same time disrupt our quality of life the least. Its goals include reducing incision size, decreasing surgical trauma and pain, and improving cosmesits, patient satisfaction, and recovery times. However, the most important goal of minimally invasive aortic valve surgery must be to maintain or improve the efficacy and safety of conventional aortic valve surgery. In this report we would like to present operative technique of minimally invasive aortic valve replacement (MIAVR) we use in our hospital.

Coronary artery spasm is one of the well-known causes of anginal chest pain. We presented the case of prolonged spasm of the left anterior descending coronary artery which happened during coronary angiography leading to pulse less state and low blood pressure with syncope and appearing of ventricular fibrillation on ECG. During one hour of successful cardiopulmonary resuscitation, the patient had again normal pulse and blood pressure. Coronary angiography performed immediately after DC's showed normal coronary angiogram. After two days the patient left the hospital without brain disorders.

INTRODUCTION In this article we would like to make an institutional report and our early experience in video-assisted right minithoracotomy approach for mitral valve surgery. CASE REPORT Surgical technique include mitral valve repair or replacement through right lateral minithoracotomy, percutaneous cannulation for venous drainage and optional femoral or distal ascendant aortic cannulation for vacuum assisted CPB, direct cross clamping of the aorta with anterograde administration of the cardioplegic solution for inducing cardiac arrest. Mean CPB time was 128 min +/- 41 min, mean Cross clamping time was 70 min +/- 14 min. Mean ICU stay was 1.2 days, while mean blood transfusion was 0.8 package/patient, no complications has occurred and the patients were discharged between the 4th and 7th postoperative day. Echocardiographically follow-up (2-6 months) showed absence of mitral valve regurgitation in the mitral repair patients and good functioning of prosthetic valves. CONCLUSION Minimally invasive mitral valve procedures through right lateral minithoracotomy might be effective alternative to full sternotomy approach in mitral valve surgery.

Nomenclature Historical Pages-1.80 m , AVD is unlikely to be required, and, therefore, 2 should not be routinely included in the CPB circuit unless required intraoperatively. This rationale would also have cost-saving implications. Our study also suffers a number of limitations. First, despite all data being prospectively recorded, it has been analysed retrospectively. Second, the patients were not randomised into either of the two groups. Third, the decision to use AVD was purely at the discretion of the surgeon and the clinical perfusionist, based on their assessment of the venous drainage, and thus a selection bias could exist. Finally, it is a relatively small study. Despite these limitations, we have observed that AVD is not essential in every patient who undergoes mAVR, and is more likely to be used in patients with a larger BSA. Partial upper re-sternotomy for aortic valve replacement or re-replacement after previous cardiac surgery. w4x Wang S, Undar A. Vacuum-assisted venous drainage and gaseous microemboli in cardiopulmonary bypass. Limitations using the vacuum-assisted venous drainage technique during cardiopulmonary bypass procedures. drainage method for cardiopulmonary bypass in single-access minimally invasive cardiac surgery: siphon and vacuum-assisted drainage. Vacuum-assisted venous drainage in single-access minimally invasive cardiac surgery. w9x DuBois D, DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Vacuum-assisted venous drainage in extrathoracic cardiopulmonary bypass management during minimally invasive cardiac surgery. Relative importance of venous and arterial resistance in controlling venous return and cardiac output. During minimally invasive valve surgery, a good exposure with a bloodless field is a prerequisite for the ease and success of the surgery. We would like to comment on the issue regarding the use of assisted venous drainage (AVD) raised by the authors w1x. AVD is an important tool available for cardiac surgeons to achieve a bloodless operating field and to empty the heart in order to perform the most important part of the valve surgery. Using direct cannulation of the right atrium might cause crowding of the operative field due to the presence of aortic, venous and venting cannulas as well as aortic-clamp and CO 2 line supply passing through the incision site. Additionally, due to the higher position of the venous cannula in the right atrium, it might need more negative pressure for AVD. Instead, cannulating the femoral vein with double-staged venous cannula (the Remote Access Perfusion Femoral Venousீ cannula, RAP FV; Estech Inc, USA) …