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Introduction: although there is the increase in the number of percutaneous procedures, coronary artery bypass grafting (CABG) remains the standard treatment for patients with extensive coronary artery disease. Coronary artery bypass graft surgery should be performed with or without extracorporeal circulation (CPB), therefore there is on-pump and off-pump CABG procedures. There is an ongoing, debate over the superiority of onpump vs. off-pump CABG methods. Both techniques have their pros and cons, and cardiac surgery units around the world have different approaches and opinio ns on the subject. Aim: to show whether there was a difference in early postoperative recovery in patients in whom cardiac bypass surgery was performed using the on-pump or off-pump CABG method and whether one type of operation was superior to the other. Material and methods: in the period from September 2021 to May 2023 isolated CABG was performed on 230 patients, divided into two groups at the Clinic of Cardiovascular Surgery of the Clinical Center University of Sarajevo. One group with 80 patients had on-pump CABG operation (with CPB), and other was with 150 patients was treated with off-pump CABG technique. Data were collected during preoperative, intraoperative and postoperative period. All patients were elective cases. Results: our study showed that there were more male patients in both group with an average age 63 years which was similar in both groups. There was statistically significant difference in number of grafts implanted in favor of on -pump CABG group. Comparing the comorbidities presented in patients in both groups, there was no significant difference, but a statistically significant difference was in the presence of anemia in favor of patients from the off -pump group, 36.7% versus 11.3%, p 0.0001. There was a statistically significant difference in mean number of blood transfusions units (1.03±1.26:0.53±1.02 units) and fresh frozen plasma (FFP) (1.96±1.35:1.37±1.39 units) in favor of on - pump group during operation. In early postoperative period, in intensive care unit (ICU), data showed significantly higher number of patients on vasopressors in off -pump group, 50.0% compared to 35.0% of cases in the on-pump group. Comparison of blood products transfusions during ICU stay indicate that there was a statistically significant difference in mean number of blood transfusions units (1.5±1.99:0.51±1.06 units) and FFP (1.0±1.41:0.51±1.06 units) in favor of on -pump group. The stay in the ICU was statistically significantly longer for the patients in the on-pump group, 3.56±1.93 days (range 2-18 days) compared to the patients in the off-pump group, 2.74±0.82 days (range 1-7 days). Other observed parameters such as the occurrence of atrial fibrillation, the amount of drainage during 48 hours, the duration of mechanical ventilation, the use of platelets and the recorded fatal outcome did not show a significant difference between the observed groups. Conclusion: the study showed that the intra- and post-operative consumption of blood and fresh frozen plasma is significantly lower if the patient underwent off -pump CABG, avoiding possible complications of transfusion use. Also, patients from the off -pump group had a shorter stay in ICU, which favors faster recovery and lower treatment costs. [ABSTRACT FROM AUTHOR]

Introduction: cardiovascular diseases (CVDs) remain the leading cause of worldwide mortality, leading cause of death and disability globally with over 17.9 million deaths in 2019, representing 32% of all deaths, and 38% of premature deaths from non-communicable diseases. Thousands of studies support the concept that controlling lifestyle risk factors for CVDs such as regular physical activity, maintenance of a proper weight, sound nutritional practices, avoiding tobacco and alcohol abuse, all significantly reduce the risk of CVD. Aim: to compare the prevalence of lifestyle risk factors for CVDs in healthcare and non-healthcare workers. Materials and methods: the study included one hundred and twenty participants, divided into two groups, medical sta ff group (doctors and nurses) with 60 participants and non-medical group (teachers and professors) with 60 participants as well. Based on the collected data from the questionnaire created for this purpose, the following results were obtained. Results: both observed groups were similar in sociodemographic data as well as in the presence of comorbidities. Our study confirmed that medical sta ff as well as non-medical, had BMI in normal range, though the value varied in medical sta ff group from 20.5 to 34.0 kg/m2 and in non-medical group from 18.5 to 34.9 kg/m2, with a mean value of 24.82 kg/m2. There was a difference in heredity, in medical sta ff group it was presented in 48.3% compared with non-medical group with 35%, but there was no statistically significant difference. Statistical difference between groups was observed in tobacco use, there were more smokers in the medical staff group 46.7%, compared to non-medical group, where the percentage of smokers was 26.7% which gives a statistically significant difference (P = 0.037). Also, In the medical sta ff group only 15% of participants were physically active, while that percentage in non-medical group was 35% (P=0.020). Conclusion: in order to obtain a better and more comprehensive profile of the presence of lifestyle risk factors for CVD in the population of medical workers, it would be necessary to conduct a study with a larger number of participants and add the way of nutrition and the existence of stress, which would process the risk factors more comprehensively. [ABSTRACT FROM AUTHOR]

Aim To assess a psychosocial impact of the Coronavirus disease 2019 (COVID-19) on health care workers and to quantify the size of depression symptoms, anxiety and stress levels. Methods This cross-sectional study used an anonymous online survey questionnaire as a research instrument and it included 114 health workers of all profiles from the Sarajevo Canton employed in private and public institutions. The research was voluntary, non-commercial and all participants provided an oral informed consent. Depression, Anxiety and Stress Scale (DASS-21) questionnaire was used for assessing emotional status of depression, anxiety and stress. Results The mean age of participants was 40.5±8.44 years with male:female ratio of 0.28. Prevalence of depression was 46.5%, anxiety 61.4%, and 36.9% stress. Age and gender had no effect on emotional status, but it was revealed that women achieved higher depression, anxiety and stress scores than men (without statistical significance). The most notable effect on the emotional state was found for direct or indirect contact with COVID-19 patients. Medical workers in direct contact with COVID-19 patients achieved greater depression (p=0.005), anxiety (p=0.001), stress (p=0.030) and total DASS-21 (p=0.003) scores. Conclusion High prevalence of health workers affected by various psychological ailments during the COVID-19 pandemic was found. This evidence underscores the need to address adverse effects of the pandemic on mental health of health care workers. [ABSTRACT FROM AUTHOR]

Introduction: Carotid endarterectomy (CEA) is an effective and safe treatment for carotid artery stenosis. Aim: to compare early outcomes after carotid endarterectomy between patients with diabetes mellitus (DM) and patients without diabetes mellitus with symptomatic carotid artery stenosis. Materials and methods: we retrospectively analyzed 161 CEAs, which were performed in patients with symptomatic carotid artery stenosis, between January 2018 and May 2022. CEAs were divided into a DM group (n=58; 36%) and a non-DM group (n=103; 64%). Study outcomes included the incidence of major adverse events (MAEs), defined mortality, stroke and myocardial infarction (MI) during the early perioperative period (0-30 days). Results: there was no statistically significant difference between the analyzed groups regarding total complications (3.4% vs 2.9%; P>0.05). Statistically significant differences were recorded in the presence of bilateral stenosis (31% vs 16.5%; P=0.046), peripheral arterial occlusive disease (32.8% vs 16.5%; P=0.029) in patients with DM. Despite these differences, patients with DM had similar perioperative outcomes compared with nondiabetic patients, including perioperative MI (1.7% vs. 0.97%; P=0,974), perioperative death (1.7% vs. 0.97%; P=0,974), and perioperative neurologic events such as stroke (0% vs. 0.97%; P=0,770). No differences in demographic factors were noted between diabetic and non-diabetic patients. Conclusions: despite the increased prevalence of bilateral stenosis and peripheral arterial occlusive disease in patients with diabetes who underwent CEAs, the rates of perioperative morbidity and mortality were without statistically significant differences. [ABSTRACT FROM AUTHOR]

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Aim: The aim of this rare case report is to present primary aortoduodenal fistula (PADF) as result of the brucella aortitis. Methods: The patient was admitted with signs of gastrointestinal bleeding and during surgery the aortoduodenal fistula has been identified. The postoperative recovery was normal and at the seventh post-operative day a fully recovered patient was transferred to regional hospital for further brucellosis evaluation and treatment. Conclusion: The primary aortoduodenal fistula is a rare complication of abdominal aortic aneurysm (AAA) and a rare cause of gastrointestinal bleeding and maybe overlooked. Therefore, detailed anamneses, physical examination, early recognition of AAA rupture with CT angiography and emergency surgery are an algorithm for successfully resolving this life-threatening disease. [ABSTRACT FROM AUTHOR]

Introduction: enhanced recovery after surgery (ERAS) is a multimodal, multidisciplinary concept of surgical patient care. There is an increasing interest worldwide in the implementation of ERAS programs, especially in cardiac surgery. The primary goal of these patient care concepts is to improve outcomes, shorten the length of hospital stay and reduce treatment costs. Aim: to present a successful implementation of ERAS in cardiac surgery in a high-risk patient who underwent minimally invasive re-do revascularization surgery. Case report: we present a 69-year-old male NYHA IV diabetic patient who underwent a high risk re-do coronary artery bypass surgery. The choice of surgical technique was the minimally invasive approach through the left anterior mini-thoracotomy to decrease the risk of surgical complications. The concept of perioperative care included main parts of enhanced recovery protocols such as early extubation, opioid-sparing analgesia, early mobilization, blood glucose level control and early oral intake. The patient was discharged home early in a stable condition. Conclusion: the multidisciplinary ERAS concept of perioperative patient care in combination with minimally invasive surgical approach enhances the overall recovery of high-risk patients and decreases the length of hospital stay as well as the treatment costs. [ABSTRACT FROM AUTHOR]

Introduction: hypertension stands as an established risk factor for AAA diagnosis. However, evidence on whether controlling blood pressure can reduce AAA growth is lacking. Aim: the variable importance assigned to systolic and diastolic BP in the literature prompted authors to propose the use of mean arterial pressure (MAP) for a more comprehensive assessment. Materials and methods: all 44 patients with an RAAA underwent urgent repair of an RAAA at the Clinic of Cardiovascular Surgery of the Clinical Center University of Sarajevo in the period from January 2021 to November 2022. Results: there was no statistically significant difference between the a nalyzed groups regarding cerebrovascular comorbidities (p=0.290), cardiac comorbidities (p=0.932), renal insufficiency (p=0.112), lethal outcome (p=0.209), while we have noticed significant difference in inotropic support (p=0.045), and postoperative complications (p=0.025). Conclusion: patients who initially presented with lower mean arterial pressure, as opposed to those subjected to aggressive fluid resuscitation, exhibited improved survival. These findings reaffirm the established tenets regarding the management of blood loss, the potential benefits of controlled inotropic support, and the criticality of mean arterial pressure in shaping patient outcomes. [ABSTRACT FROM AUTHOR]

Aim This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery (MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG). Methods This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients with indication for surgical revascularization. Results Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28). Conclusion Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets. [ABSTRACT FROM AUTHOR]

Introduction: the mortality and morbidity rate due to abdominal aortic aneurysm rupture (RAAA) still remains high. In order to improve the final outcome surgical decision-making involves quickly evaluating. To enhance the objectivity and efficacy of surgical treatment, a prediction of RAAA outcomes is crucial. Several models have been developed to predict death after intervention in patients with an RAAA. Glasgow Aneurysm Score is one of the most commonly used models. Aim: to evaluate the accuracy of the most frequently used GAS system in predicting mortality and its practical use in clinical decision-making. Materials and methods: a retrospective, comparative cohort study was conducted in all 86 consecutive surgically treated patients with an RAAA in the Clinic of Cardiovascular Surgery of the Clinical Center University of Sarajevo in the four years period, from June 2019 to June 2023. Glasgow Aneurysm Score (GAS) was calculated and compared with final score. Results: the results show that total mortality rate was 23.3%, the mean GAS for the 86 patients who underwent surgery was 100.33 +/- 17.57. No statistically significant difference in GAS values was found between patients who die d and patients who survived surgery and in the 30-day postoperative period. Conclusion: our research has shed light on the limitations of existing scoring systems, including the Glasgow Aneurysm Score system. [ABSTRACT FROM AUTHOR]

Introduction: the research is concerned with acute renal insufficiency (AKI) occurring after the rupture of an abdominal aortic aneurysm. Aim: to determine the incidence rate of AKI in the total sample, and the two groups comparatively, and to determine independent predictors of AKI. Materials and methods: the sample consisted of 43 patients surgically treated at the Clinic of Cardiovascular Surgery of the Clinical Center University of Sarajevo in the period from 1 January 2021 to 3 1 March 2023, due to an abdominalaortic aneurysm rupture. The research was designed as an observational prospective analysis modeled on a typical cohort study. The sample was divided into two groups by the criterion determining the degree of hemorrhagic shock. Results: the incidence of survival after aortic trunk reconstruction due to abdominal aortic aneurysm rupture was 67.4%. In the total sample, 79.16% of patients had at least one form of AKI. A statistically significant disproportion between the groups is evident for AKI stage 0, as there were no patients without renal symptoms in Group 2 (p=0.004). Patients with hypertension more often showed severe types of hemorrhagic shock and consequent AKI (p<0.001). Preoperatively elevated values of serum creatinine denote a significant predictor of the occurrence of AKI (p<0.046). Conclusion: the occurrence of AKI after urgent surgical reconstruction of the aorta due to aneurysm rupture is a significantly frequent problem. The research determined intraoperative hemodynamic instability, blood loss exceeding 1500ml, and preoperative elevated serum creatinine levels as risk factors for postoperative AKI. Preoperatively elevated serum creatinine level is also a safe independent predictor of acute kidney function disorder in the postoperative period. [ABSTRACT FROM AUTHOR]

Aim To compare outcomes of two different surgical techniques of coronary artery bypass grafting (CABG) for treating isolated left anterior descending (LAD) coronary artery disease by full median sternotomy technique vs. minimally invasive approach via left anterior mini-thoracotomy. Methods This retrospective, observational study, which included 61 elective patients, was conducted at the Clinic for Cardiovascular Surgery of the Clinical Centre of the University of Sarajevo in the period from June 2019 to January 2022. Patients were divided in two groups according to the operative technique used, the sternotomy CABG group of 30 patients where the access considered full median sternotomy, and the minimally invasive CABG group where left anterior mini-thoracotomy was performed. The groups were compared by previously defined primary and secondary clinical postoperative outcomes. Results Out of 61 patients, the majority was males, 50 (82%). The analysis of the outcomes of the minimally invasive CABG surgery showed significantly shorter operative times (p=0.001), less postoperative drainage (p=0.001) and transfusion requirements, shorter mechanical ventilation duration (p=0.0001), low major adverse cardiac and cerebrovascular events rates, as well as shorter Intensive Care Unit stay days with mean of 3.3±1.442 days (p=0.025), but no total hospital stay days with mean of 6.7±1.832 days (p=0.075) compared to sternotomy CABG group. Conclusion Minimally invasive approach for CABG surgery in treating isolated single vessel LAD disease, together with the fasttrack protocol, offers a reasonable alternative to full median sternotomy, leading to faster patients' overall recovery and improving the quality of life. [ABSTRACT FROM AUTHOR]

Horseshoe kidney is a relatively rare congenital anomaly with different types of fusion and specific blood supply. Incidence of the co-existence of horseshoe kidney and abdominal aortic aneurysm is even rarer. This unusual condition is also a kind of technical challenge for the vascular surgeon during the time of aneurysm repair. Our article presents a case report of abdominal aortic aneurysm repair in a patient with horseshoe kidney. [ABSTRACT FROM AUTHOR]

Objective: this study was conducted to determine the results of the left subclavian artery (LSA) coverage during Thoracic Endovascular Aortic Repair (TEVAR). Materials and methods: we retrospectively reviewed the results of 22 patients who underwent TEVAR from January 2013 to May 2014. The LSA was completely covered in 18 patients (13 male, 5 female), with a mean age of 62 years (range 36-81 years of age). There was no revascularization. The mean follow-up was 8 months (range 1-12 months). Results: indications for TEVAR treatment included aneurysm in 7, dissection in 3, combination of aneurism and dissection in 4, pseudoaneurysm in 1, aortic injury in 1, and penetrating ulcer in 2 cases. Out of this number of cases, 16 were elective and 2 emergency operations. Aortic coverage extended from the left common carotid artery (LCCA) to the distal arch (1 patient), middle thoracic aorta (3 patients). Operative success was 99%. In our study we did not record 30-days mortality, paraplegia appearance or stroke related to LSA coverage. Left upper extremity symptoms developed in 2 patients (10%) by subclavian steal syndrome. Permanent left upper extremity dysfunction or ischemia was not found. Conclusion: landing Zone 2 TEVAR with LSA coverage can be accomplished safely in both elective and emergency settings without revascularization and long-term damage to the left arm. [ABSTRACT FROM AUTHOR]

Aim To compare outcomes of two different surgical techniques of coronary artery bypass grafting (CABG) for treating isolated left anterior descending (LAD) coronary artery disease by full median sternotomy technique vs. minimally invasive approach via left anterior mini-thoracotomy. Methods This retrospective, observational study, which included 61 elective patients, was conducted at the Clinic for Cardiovascular Surgery of the Clinical Centre of the University of Sarajevo in the period from June 2019 to January 2022. Patients were divided in two groups according to the operative technique used, the sternotomy CABG group of 30 patients where the access considered full median sternotomy, and the minimally invasive CABG group where left anterior mini-thoracotomy was performed. The groups were compared by previously defined primary and secondary clinical postoperative outcomes. Results Out of 61 patients, the majority was males, 50 (82%). The analysis of the outcomes of the minimally invasive CABG surgery showed significantly shorter operative times (p=0.001), less postoperative drainage (p=0.001) and transfusion requirements, shorter mechanical ventilation duration (p=0.0001), low major adverse cardiac and cerebrovascular events rates, as well as shorter Intensive Care Unit stay days with mean of 3.3±1.442 days (p=0.025), but no total hospital stay days with mean of 6.7±1.832 days (p=0.075) compared to sternotomy CABG group. Conclusion Minimally invasive approach for CABG surgery in treating isolated single vessel LAD disease, together with the fasttrack protocol, offers a reasonable alternative to full median sternotomy, leading to faster patients' overall recovery and improving the quality of life., (Copyright© by the Medical Assotiation of Zenica-Doboj Canton.)