Introduction Mitral valve abnormalities in rheumatic heart disease commonly lead to functional tricuspid regurgitation. Tricuspid annuloplasty (TA) is often performed in these cases along with mitral valve replacement (MVR). Our aim was to compare the perioperative morbidity and mortality among those patients that underwent mitral valve replacement with tricuspid annuloplasty versus those that underwent isolated mitral valve replacement. Methods A retrospective analysis of 158 patients that underwent mitral valve replacement, with or without tricuspid annuloplasty, secondary to rheumatic heart disease between January 2017 and August 2020. Patients who underwent additional cardiothoracic surgical procedures (aortic valve replacement and coronary artery bypass grafting) were excluded to reduce confounders. Results The study group consisted of 158 patients (mean age 41; 73 male, 85 female) that underwent MVR with TA (n=22; 13.9%) or without TA (n=136; 86.1%). Both groups had similar comorbidity frequencies and medication history. Preoperative echocardiography showed a comparable degree of pulmonary hypertension and ejection fraction between the two groups. The TA+MVR group had similar intraoperative (81.8% vs 66.9%; p=0.161) and postoperative (45.5% vs 45.6%; p=0.991) blood products usage compared to the MVR only group. Concurrent TA resulted in similar in-hospital mortality (4.5% vs 4.4%; p=0.977) as well as early postoperative complications, namely, prolonged ICU stay (13.6% vs 10.3%; p=0.639), prolonged ventilation (0 vs 2.2%; p=0.482), re-intubation (9.1% vs 2.9%; p= 0.161), and reopening for bleeding tamponade (0 vs 5.1%; p=0.276).

Objectives: In this study we determine the modifiable factors related to bleeding and transfusion in post-cardiac surgery patients who underwent open heart surgery. Methods: This is a retrospective study that include two hundred patients who had undergone open heart surgery (OHS) at Northwest General Hospital and Research Center from December 2018 to July 2021. Platelet count and hemoglobin level were measured in the pre-operative period. Results: This study included both male and female patients. Postoperative platelets were counted as follow: 50-100 x109 L in 3.0% cases, 101-150 x109 L seen in 27.5% cases, and >150 x 109 L in 69.5% cases which required transfusion. We have also reported the increased requirement of transfusion of blood and blood products in patients with pre-operative hemoglobin (Hb) < 10 g/dl. Conclusion: Correction of pre-op Hb, post-op platelet count and total bypass time are the significant and preventable parameters in patients undergoing cardiac surgery if proper pre-op assessment of the patient is performed. doi: https://doi.org/10.12669/pjms.38.4.5685 How to cite this:Khan B, Mujahid Ul Islam, Ahmad I, Mujeeb Ur Rehman. Modifiable Risk Factors associated with Post-Operative Bleeding and transfusion requirements in Cardiac Surgery. Pak J Med Sci. 2022;38(4):---------.  doi: https://doi.org/10.12669/pjms.38.4.5685 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A unique case of an abdominal aortic aneurysm replacement in a young man of Caribbean descent is presented. The initial working diagnosis was of a mycotic aneurysm, which has recently shown resurgence with intravenous drug abuse. Blood tests and subsequent biopsy ruled that out. There was also a clinical suspicion of a connective tissue abnormality. Histological examination of the aneurysm, skin biopsy, and blood tests also ruled out this possibility. The graft used in this patient was from a new generation of grafts. In the absence of any studies on such grafts, there is the question of long term durability of the graft.

Objective: To find the incidence of intra-aortic balloon pump (IABP) induction and factors associated with its insertion in coronary artery bypass grafting (CABG). Methods: This retrospective observational non interventional study was conducted at Cardiac Surgery Department, North West General Hospital and Research Center, Peshawar from December 2018 to March 2020. The total sample size was 360 patients who underwent coronary artery bypass grafting (CABG). The research was piloted in the cardiac operation theatre then cardiac intensive care unit (CICU) of Northwest General Hospital and Research center Hayatabad Peshawar. Data was collected from 360 patients scheduled for CABG. Total numbers of patients in whom IABP was inserted and factors associated with IABP insertions were noted. All the information was collected on a specifically prepared Form. Data was entered and evaluated in statistical package for social sciences form 25. Results: In this study, a total of 360 patients were observed who underwent coronary artery bypass grafting (CABG). We determined the frequency of IABP induction and the factors related to it. Gender distribution among patients who were assisted with IABP was 43% female and 57% male. IABP induction was done for most of moderately to severely reduced ejection fraction patients. Other factors related to patients who required IABP support were previous myocardial infarction 100%, hypertension 86%, diabetes mellitus 64%, coronary end-arterectomy 21% and smoking 7%. The results were analyzed. We have used the (SPSS) version 25 and Chi-square test for analysis in which the P-value less than 0.00001 is statistically significant. Conclusion: Incidence of insertion of IABP among CABG population was 3.9% in our hospital. It is an essential support to post CABG patient with left ventricular dysfunction after cardiopulmonary bypass with moderate to severely reduced ejection fraction, Myocardial infarction, hypertension, diabetes mellitus. Smoking and endarterectomy were not significantly related to IABP induction in our study. Multicenter study is still required to find out the other factors governing the IABP insertion. Abbreviations:CABG: Coronary Artery Bypass Grafting Surgery, EF: Ejection Fraction, CAD: Coronary Artery Disease, PCI: Percutaneous Coronary Intervention, ICU: Intensive Care Unit, IABP: Intra-aortic Balloon Pump, CICU: Cardiac Intensive Care Unit, MI: Myocardial Infarction. doi: https://doi.org/10.12669/pjms.37.2.3614 How to cite this:Ahmad I, Mujahid Ul Islam, Mujeeb Ur Rehman, Khan B. Frequency of intra-aortic balloon pump insertion and associated factors in coronary artery bypass Grafting in a tertiary care hospital. Pak J Med Sci. 2021;37(2):---------.  doi: https://doi.org/10.12669/pjms.37.2.3614 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Spinal anesthesia has been considered preferred method of anesthesia for patients undergoing elective cesarean sections. Dexmedetomidine (DXM) is relatively a newer drug in Pakistan as compared to conventional used drug i.e. Bupivacaine (BPV) and that’s why the local data regarding its efficacy in cesarean section is lacking. Objective: To compare the mean duration of spinal anasthesia between hyperbaric bupivacaine 0.5% alone versus hyperbaric bupivacaine 0.5% with dexmedetomidine on first analgesic request for women undergoing elective cesarean section under subarachnoid block Methods: Spinal anesthesia was performed in the sitting position under sterile conditions with 25G pencil point needle. After successful intra thecal injection, patient was placed in the supine position with left tilt. The cases in Group A received hyperbaric 0.5% BPV (2.25ml) with 5ug DXM (0.25ml) and those in Group B received only 0.5% BPV (2.25ml) with 0.25ml normal saline under full aseptic measures. These patients underwent cesarean section and were assessed in post-operative time after every 30 minutes to first request of analgesia which were given if there was pain of 4 or more on visual analogue scale. Results: In Group A, mean and SDs for duration of analgesia was 359.73+8.021 minutes. In Group B, mean and SDs for duration of analgesia was 182.30+7.720 minutes Conclusions: In this study, hyperbaric bupivacaine 0.5% with DXM in spinal anesthesia for patients undergoing caesarean section significantly prolonged the duration of analgesia

To determine the incidence of endotracheal reintubation, excluding surgical reopening, in post-cardiac surgical patients in a tertiary care hospital. Material and methodsA retrospective descriptive analysis of 408 patients who underwent different cardiac surgeries during this period. Post-operative extubation was performed when patients fulfilled the preset criteria for extubation, which include consciousness (awake and aware), stable vital signs, acceptable arterial blood gases, acceptable respiratory mechanics, a maximum inspiratory force greater than 20-25 cm H 2 O, chest tube drainage less than 100 ml per hour, normal temperature and electrolytes. The total number of patients who were reintubated within 72 hours of extubation was noted. The criteria for reintubation included altered conscious level with Glasgow Coma Score (GCS) of less than 8, respiratory failure, unstable hemodynamics, and arrhythmias such as ventricular tachycardia (VT) and fibrillation. All of the information was collected retrospectively on a specifically prepared form. Data was entered and evaluated in Statistical Package for the Social Sciences.

Background: Majority of the patients presenting for coronary artery bypass surgery are preoperatively on clopidogrel and aspirin i.e., Dual antiplatelets therapy (DAPT) because of high incidence of left main stem disease, acute coronary syndrome and diffuse coronary artery disease. Preceding coronary stenting and coming from far flung areas even from other countries with poor socioeconomic status contributes to continuation of DAPT till surgery. The main objective of the study was to evaluate hospital complications like chest tube output, re-explorations, blood, and blood product administration and in-hospital mortality in patients who continued DAPT till 48 hours prior to surgery versus those who continued DAPT until 48 to 120 hours before surgery. Methods: Preoperative history, perioperative and postoperative data of patients was gathered retrospectively from 1st July to 31st December 2019 in a tertiary care hospital of Peshawar. Total patients undergoing CABG Surgery were 223. From those 223 patients 192 patients were on DAPT. We than divided the 192 patients into two groups, Group A and Group B. 102 patients (Group A) received clopidogrel plus aspirin until 48 hours before surgery, and 89 patients (Group B) continued clopidogrel 48 to 120 hours prior to surgery. Chest tube output, need for exploration, in-hospital mortality, and blood or products transfusions among both groups were compared. Results: In terms of bleeding complications no significant difference between the both groups with similar chest drainage in the first 24 hours (602 ml and 609ml). In group A 33 patients received blood transfusion compared to 25 patients from group B. There was no significant difference in the amount of platelets given to group A (0.63 L) and to group B was (0.60 L). On the other hand, Group, A received 1.08 L fresh frozen plasma (FFPs) transfusion and group B 1.10 L respectively. Re-exploration was observed in Group A and B as (3 vs 2). Mortality was observed in 7 patients from group A and 2 from Group B. Conclusions: Usage of Dual antiplatelets therapy (DAPT) before surgery was an effective treatment method for postoperative complication of bleeding. It was suggested that with proper management with DAPT before surgery was planned is an effective and safe treatment method.. Keywords: Cardiopulmonary surgery, Coronary bypass grafting, hemoglobin, platelets, bleeding.

Change in dietary habits with reduction in specific type of foods with heavy calories may help in prevention of many types of primary and secondary Cardiovascular Diseases (CVD). Coronary artery disease (CAD) is the most common cause of death all over the world and mostly treated by Coronary Artery Bypass Grafting (CABG). The recommended diet according to the guidelines, is high in fruits, vegetables and whole grains and is low in high fats and processed foods. The factors involved in consumption of low-quality diet mainly are lack of public awareness about the role of dietary style in development of CVD, lack of food due to low socioeconomic conditions, cultural and traditional differences of food preparation and availability of poor-quality food in markets Objectives: To assess the level of awareness amongst the patients of coronary artery bypass grafting in its worst form. Methods: The study was performed on 91 patients of CAD, admitted for CABG in tertiary care hospital. A questionnaire-based survey was conducted for a period of eight months. All patients admitted for revascularization for CAD were included. Details of patients co morbidities were collected and their socioeconomic status was confirmed from the medical record. They were scored on their general education, knowledge about heart healthy diet according to American Heart Association (AHA) dietary guidelines and their dietary practices were scored healthy or non-healthy based on their answers. Results: Among the patients, approximately, 75.82% were males, 96.7% had age above 49 years, half of the patients had some sort of awareness regarding heart healthy diet, 37% were following healthy diet, 50% were partially following and 4.4% were not following at all. Conclusion: The awareness of participants regarding heart healthy diet was over all poor and also their dietary practices were even worse and not in accordance to the medical recommendations. There is a need to increase awareness in heart patients regarding healthy diet choices so that their risk of disease progression can be reduced