https://jctm.mums.ac.ir/ Journal of Cardio-Thoracic Medicine en daily 1 Mon, 01 Jun 2026 00:00:00 +0330 Mon, 01 Jun 2026 00:00:00 +0330 https://jctm.mums.ac.ir/article_27945.html Introduction: Complex aortic surgeries are associated with a considerable risk of perioperative neurological complications, mainly due to cerebral hypoperfusion, ischemia, or embolic events. Early recognition of cerebral oxygen imbalance during surgery may help in reducing postoperative neurological morbidity. Near-infrared spectroscopy (NIRS) offers a non-invasive method for continuous monitoring of regional cerebral oxygen saturation (rSO₂).Methods: This observational study included 50 adult patients undergoing complex aortic surgery. Baseline cerebral rSO₂ values were recorded using NIRS before induction and monitored throughout the intraoperative period. Cognitive function was assessed using the Standard Mini-Mental State Examination (SMMSE) before surgery and again in the postoperative period. Intraoperative changes in NIRS values were compared with postoperative SMMSE scores to evaluate cognitive decline and delirium. Additional clinical outcomes, including duration of mechanical ventilation and length of intensive care unit stay, were also analyzed.Results: A fall in intraoperative cerebral rSO₂ was associated with a reduction in postoperative SMMSE scores, indicating postoperative cognitive decline in a subset of patients. Patients with lower intraoperative NIRS values also showed a tendency toward prolonged ventilation and longer intensive care unit (ICU) stay. Postoperative cognitive dysfunction was observed in approximately 10% of the study population.Conclusion: Intraoperative NIRS monitoring may be a useful adjunct in complex aortic surgeries for detecting cerebral desaturation and identifying patients at risk of postoperative cognitive dysfunction. Reduced rSO₂ values were associated with poorer neurological recovery, prolonged ventilation, and increased ICU stay. https://jctm.mums.ac.ir/article_27779.html Introduction: Minimally invasive cardiac surgery (MICS) has redefined mitral valve replacement (MVR), but its adoption in low- and middle-income countries (LMICs) is limited by resource constraints and cost-effectiveness concerns. This study evaluates single-incision right mini-thoracotomy with central cannulation as a feasible and economical alternative to sternotomy.Methods: A retrospective analysis was performed on 250 patients who underwent MVR via right mini-thoracotomy with central cannulation between January 2014 and June 2017 at a high-volume tertiary center in Western India. Demographics, New York Heart Association (NYHA) class, valve pathology, operative data, complications, hospital stay, and early outcomes were reviewed. Economic benefit was assessed in terms of hospital stay, recovery, and avoidance of groin-related vascular interventions.Results: The mean age was 32.5 years, with most patients in the 3rd–4th decades. Rheumatic disease accounted for 89% of cases, degenerative disease 10%, and infective endocarditis 1%. Mean incision length was 7.2 cm. Cardiopulmonary bypass and operative times were comparable to sternotomy, with prolongation in 10% of cases. Drainage was <100 mL in 60% of patients. Most (85%) were discharged by postoperative day 5, with average stay 4–7 days. At two months, 94% of survivors were in NYHA class I–II. Mortality was 0.5%. Cost savings were achieved by shorter hospitalization, faster recovery, and avoidance of groin complications.Conclusion: Right mini-thoracotomy MVR with central cannulation is safe, reproducible, and cost-effective. It reduces trauma, accelerates recovery, improves cosmesis, and avoids vascular complications, making it a practical minimally invasive option in LMICs. https://jctm.mums.ac.ir/article_27370.html Introduction: Acute kidney injury (AKI) after cardiac surgery is associated with increased morbidity and mortality. Risk factors for AKI during off-pump coronary artery bypass grafting (OPCAB) are poorly understood. Our aim in this study is to identify the relationship between perioperative parameters and AKI following OPCAB.Method: This prospective observational study was conducted in a single tertiary cardiac center. A total of 175 patients undergoing elective isolated CABG were included in this study over a 2-year period (March 2021 – February 2023). Out of 175 patients, 34 developed acute kidney injury after off-pump coronary artery bypass grafting surgery. Their preoperative, intraoperative, and postoperative findings were compared to identify the independent risk factors for developing postoperative acute kidney injury.Result: The study was conducted on 175 patients: 113 males (64.5%) and 62 females (35.5%). Their age ranged from 61.81±8.30 years. In the AKI group patients, independent risk factors for developing postoperative AKI consisted of age>70 years (P<0.0001), BMI>30kg/m2 (P=0.015), diabetes, high HbA1c level (>6.5%) (P=<0.001), hypertension (P<0.001), no intake of calcium channel blockers for hypertension (P=<0.001), EF<30%, and timing of angiography before surgery (< 14days) (P=0.005).Conclusion: Independent risk factors for developing postoperative AKI consist of age>70 years, BMI>30kg/m2, diabetes, high HbA1c level (>6.5%), hypertension, no intake of calcium channel blockers for hypertension, EF<30%, timing of angiography before surgery (<14 days), Acute MI (<30 days), High serum lactate level at 12 hours post-ICU admission, high vasoactive inotropic score, and requirement of blood transfusion due to various reasons. Among all these variables, mortality was found as a strong predictor in AKI group patients (p=0.016, OR=14.95, 95%CI 1.64-136.08). https://jctm.mums.ac.ir/article_27725.html Introduction: We aimed to evaluate the pilgrims’ satisfaction with the health, medical, and pharmaceutical services in Mashhad at the end of Safar.Methods: This was a cross-sectional study conducted in the Safar Lunar Month. Pilgrims were recruited using a convenience sampling method of individuals entering Mashhad city.Results: A total of 6497 pilgrims participated in the study. Out of those, 409 pilgrims (6.3%) required some medical services. Approximately 175 people (42.7%) rated the quality of access to medical services as average or below average. In terms of emergency services, 93 pilgrims (1.4%) required assistance, with 54.9% (n=42) reporting below average satisfaction with treatment by emergency personnel. Additionally, 1134 individuals (17.7%) expressed that the hygiene of their accommodations was average or below average.Conclusions: Regarding the low satisfaction of pilgrims with the health and medical services during the peak of travel, it is necessary to improve the healthcare system services to empower pilgrims to access better healthcare. https://jctm.mums.ac.ir/article_27854.html Objective: To analyze an epidemiological model of coronavirus disease 2019 (COVID-19) transmission and identify patient characteristics associated with disease severity‎.‎Materials and Methods: An extended SIR-based compartmental model was developed‎, ‎incorporating asymptomatic/symptomatic classes‎, ‎hospitalization‎, ‎ intensive care unit (ICU) admission‎, ‎mortality‎, ‎reinfection‎, ‎and environmental transmission‎. ‎The basic reproduction number ‎ ) was derived‎, ‎and stability analysis was performed using Routh-Hurwitz and Castillo-Chavez criteria‎. ‎Numerical simulations were conducted using MATLAB with data from Mashhad University of Medical Sciences‎.Results: The disease-free equilibrium is stable when ‎ <1‎. ‎Clinical findings show‎: ‎diabetic patients are twice as likely to develop severe symptoms; hypertensive patients have a 3.5-fold higher risk (20% mortality vs‎. ‎0.7%); men have seven-fold higher mortality than women; older adults (>40 years) show increased severity; and obese patients (BMI ≥30) have worse outcomes‎.Conclusion: is a critical parameter for disease-free equilibrium stability‎. ‎Comorbidities (diabetes‎, ‎hypertension‎, ‎obesity) and demographic factors (older age‎, ‎male gender) significantly increase the risk of severe COVID-19 outcomes‎. https://jctm.mums.ac.ir/article_27775.html Elephantiasis, characterized by chronic lymphatic obstruction and massive limb swelling, poses significant challenges in surgical management due to altered anatomy, difficulty in vein harvesting, impaired wound healing, and an increased risk of infection and fluid imbalance. These complications become especially critical when major procedures like coronary artery bypass grafting (CABG) are required. In such patients, standard surgical approaches may be compromised, demanding tailored strategies to minimize risk and optimize outcomes. We present a rare case of CABG using total arterial revascularization (TAR) in a patient with elephantiasis, illustrating the complexities of operative planning and execution in the presence of severe lymphatic disease. This case emphasizes the importance of preoperative assessment, multidisciplinary collaboration, and meticulous intraoperative technique. Careful postoperative monitoring is also essential to prevent complications and ensure successful recovery. Our report highlights that individualized approaches can lead to favorable outcomes even in technically demanding situations, demonstrating the viability of arterial grafting in anatomically and physiologically demanding scenarios.