Objective: To compare the early outcome of Coronary Artery Bypass Graft surgery using a combination of antegrade and retrograde cardipoplegia with that utilizing antegrade cardioplegia alone in triple vessel coronary artery disease. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Adult Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Sep 2013 to Apr 2019. Methodology: A total of 160 patients with triple vessel coronary artery disease who underwent CABG surgery for 90% or greater stenos is in at least one major vessel in each of the three territories, namely the left anterior descending, the circumflex and the right coronary artery were investigated retrospectively. These were divided into 2 equal groups on the basis of the technique of administration of cardioplegia: in group-1 only ante grade blood cardioplegia was administered for myocardial protection and group-2 was given ante grade and retrograde cardiolplegia. Clinical outcomes like peri-operative mortality and morbidity were recorded, and serum creatine kinase MB, lactate, and mixed venous oxygen saturation levels were monitored. Two dimensional echocardiogram was performed on the 6th post-operative day and follow-up visits were planned 1 week and 4 weeksafter discharge from hospital. Results: There were 2 (2.5%) early deaths in group-1 and no peri-operative mortality in group-2. Five patients in group-1 (6.25%) and 2 (2.5%) in group-2 had non-fatal peri-operative myocardial infarction. However, significant differences included increased incidence of intra-operative ventricular dysrythmias, higher CK-MB levels at 24 hours after surgery, and increased requirement of intra-aortic balloon pump and inotropic support in Group-1. Conclusion: We conclude from this study that the combined delivery of ante grade and retrograde cardioplegia during CABG surgery for triple vessel coronary artery disease provides better myocardial protection and hence better outcome than antegrade cardioplegia alone.Keywords: , , ,
Objective: To study the early outcomes of mitral valve surgery performed with a beating heart and cardiopulmonary bypass. Study Design: Prospective descriptive study. Place and Duration of Study: Cardiac Surgery department, Rawalpindi Institute of Cardiology, Rawalpindi, from Aug 2017 to Aug 2019. Methodology: Consecutive patients requiring mitral valve surgery were included in the study. Those requiring multiple procedures, redo procedures and emergency procedures were excluded from the study. Data was collected on preformed proformas and perioperative variables were recorded. Patients were followed till discharge or 30 days after the surgery. Statistical Package for Social Sciences version 23.0 was used to analyse the data. Results: A total of 27 patients were included in the study, 21 (77.78%) female and 6 (22.2%) male patients. The mean age of the patients was 30.89 ± 10.8 years. Of the cohort, 4 (14.8%) had mitral stenosis, 16 (59.3%) had mitral regurgitation and mixed disease (both mitral stenosis and mitral regurgitation) was present in 7 (25.9%). The median pulmonary artery pressure (mPAP) was 34 mmHg. All the patients received mechanical mitral valve prosthesis, 27 (100%). A modified Devaga’s procedure for tricuspid valve repair was done in 4 (14.8%) patients. Most of the patients required only mild inotropic support, 22 (81.4%). Median intensive care unit stay was 24 hours with a mean of 33 ± 16 hours. All the patients were alive at the end of the early follow up. Conclusion: Beating heart mitral valve surgery on cardiopulmonary bypass is a feasible technique. It has acceptable early outcome in terms of mortality and major morbidity indicators.
Objective: To compare the incidence of sternal wound dehiscence between simple interrupted vs. figure-of-eight sternal closure techniques for median sternotomy in patients undergoing coronary artery bypass graft surgery. Study Design: Comparative prospective, randomized control trial. Place and Duration of Study: Study conducted at Department of Cardiac Surgery, Armed Forces Institute of Cardiology Rawalpindi, from Apr to Dec 2019. Methodology: A total of 206 patients were included in study. These patients were divided into two groups; group “A”: cases which will undergo simple interrupted sternal wire closure technique (n1=103). Group “B”: cases which will undergo figure-of-eight sternal wire closure technique (n2 = 103). Results: There were no statistical difference in the pre-operative data of the patients. The incidence of sternal wound dehiscence in simple interrupted closure was 6.79% while in figure of eight closure technique it was noted to be 1.94%. A statistically significant difference was noted in both the closure technique (p<0.05). Conclusions: Figure-of-eight sternal wire closure technique provides better strength and stability to sternum along with reduced incidence of sternal wound dehiscence as compare to simple interrupted wire closure.
Objective: Transfusion of residual blood left in the cardiopulmonary bypass circuit is recommended. Whether this blood should be processed or not before transfusion is not known. Study Design: A prospective non-randomized case control study. Place and Duration of Study: A tertiary care heart center, from Jan 2016 to Dec 2018. Methodology: A prospective non-randomized case control study was designed. Consecutive patients operated at a tertiary care hospital were included in the study who underwent different open-heart procedures on cardiopulmonary bypass. Patients were divided into two groups. Those who received the unprocessed residual blood transfusion, residual volume retransfused at the end of cardiopulmonary bypass and those who did not, residual volume not retransfused (RVNR). Important perioperative data was collected from the hospital database andanalyzed using IBM SPSS-statistics 23.0 (IBM, SPSS Inc., Chicago, IL). Results: Of the 120 patients, 56 patients were included in the RVR group and 64 in the RVNR group. Mean age in the RVR group was 49.41 ± 14.38 years and in the RVNR group 49.27 ± 16.36 years (p=0.96). Female patients were 9 (16.07%) in the RVR group and 20 (31.25%) in the RVNR group. Residual blood left in the circuit was 271.43 ± 52 ml in the RVR group and 264.06 ± 54.5 ml in the RVNR group (p=0.45). Hemoglobin measured in ICU was 10.5 ± 1.12 gm/dl in the RVR group and 9.97 ± 1.25 gm/dl in the RVNR group (0.02). Blood products were needed in 27 patients in RVR group and 21 patients in RVNR group (p=0.57). There was no significant difference between the two groups with respect to total drainage in the first 24 hours (p=0.89). Similarly, the re-exploration rates were not different between the two groups (p=0.50). Conclusion: Re-transfusion of residual blood left in the CPB circuit is a safe practiced. If this blood is transfused in an unprocessed form, it does not lead to adverse outcomes.
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