ETD Collection

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2015 - 20193

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    Impact of dexmedetomidine on postoperative biomarkers,length of hospitalisation and mortality in patients undergoing coronary artery bypass graft surgery
    (2019) Motshabi, Palesa Mamoseki Violet
    Coronary artery bypass graft surgery, a surgical procedure performed to alleviate the symptoms of ischaemic heart disease and improve prognosis on cardiopulmonary bypass, is beneficial in patients with ischaemic heart disease, however it is not without deleterious adverse clinical events and mortality due to its associated inflammatory and stress response. Dexmedetomidine, an a–2 adrenergic agonist, is a promising drug with a potential towards myocardial protection due to its favourable pharmacological profile. This study investigated the impact of dexmedetomidine compared to placebo on high sensitivity troponin in patients undergoing coronary artery bypass graft surgery on cardiopulmonary artery bypass in a randomised controlled trial. Secondary endpoints included mortality and the length of hospitalization. Subsequently, a systematic review and meta-analysis of randomised controlled trials on the effects of dexmedetomidine on conventional troponin (cTn) compared to control was conducted.
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    An audit of permanent pacemaker implantations at the Charlotte Maxeke Johannesburg academic hospital from 2009 - 2018
    (2019) Mabika, Mazwi
    Background: Transvenous permanent pacemakers are electronic impulse generators indicated for implantation in patients with symptomatic bradycardia, commonly due to atrioventricular (AV) heart block or sick sinus syndrome. Biventricular cardiac resynchronisation therapy (CRT) pacemakers are indicated for implantation in patients with refractory, symptomatic heart failure with a broad QRS complex of more than 130 milliseconds. A large body of epidemiological data on permanent pacemaker implantation indications and complication rates originates from the developed world with minimal data from developing regions, especially sub-Saharan Africa. This study aims to describe and analyse the patient demographics, clinical indications, peri-operative and long-term complications as well as to find independent predictors of complications in patients undergoing permanent pacemaker implantation (PPI) at a high volume, teaching hospital in Johannesburg, South Africa. Methods: We retrospectively reviewed inpatient and outpatient medical records for all patients who underwent PPI at the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH) between January 2009 and November 2018. Patients’ demographic data, medical co-morbidities, clinical indications, peri-implant laboratory biochemical markers, details of pacemaker mode and peri or post-procedure related complications were noted. Patients 18 years of age and above undergoing their first impulse generator implantation were eligible for analysis. Results: One thousand and sixty patients underwent permanent pacemaker implantation during the ten years. Only 578 (55%) patients met the study inclusion criteria. The median age at first permanent pacemaker implantation was 71.8 years [IQR: 61.5 – 78.8], and the study cohort consisted of 327 (56.6%) females. A total of 43 (7.45%) patients who experienced PPI related complications were identified. Lead dislodgement was the most common complication occurring in 16 (2.77%) patients. Females were three times more likely to experience a complication [OR: 3.21 CI: 1.37 – 7.56]. Conclusion: This study demonstrates that, in our cohort, symptomatic bradycardia requiring pacing is mostly a disease of the elderly with AV block being the most common indication for PPI. Our study complication rates are similar to those reported in data published from the developed world. Large, multicenter, prospective studies are required from our region to define better clinically relevant risk factors associated with PPI complications.
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    Sudden cardiac arrest in school athletes: understanding the role of pre-participation screening.
    (2015-04-13) Anderson, Peter William Henry
    ABSTRACT Background Sudden cardiac arrest in young athletes is a tragic event that can potentially be reduced through the implementation of a pre-participation screening program. While the absolute contents of this program are debated, consensus does exist, that should such a program be implemented, a reduction in mortality will be found. The emphasis of any pre-participation screening is found in a history and basic physical examination, with or without routine electrocardiogram testing. This is based on the understanding that 90% of sudden cardiac arrests are attributable to an underlying cardiac pathology with the majority being hypertrophic cardiomyopathy. Debate continues around the cost effectiveness of such a program but there is no doubt that in a society that is promoting an active lifestyle and with the pressure of competitive sport at most schools, there is likely to be zero tolerance for not being able to screen for potentially lethal cardiac pathology.