Background: In recent years, the use of del Nido cardioplegia, initially intended for paediatric cardiac surgery, has been extended to adult cardiac surgery in many institutions. Our aim was thus to compare the outcomes of the use of del Nido cardioplegia with that of conventional cardioplegia and discuss its role in both adult and paediatric cardiac surgery. Method: A systematic literature search was conducted in August 2019 on Medline (via PubMed), Embase and Cochrane electronic databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Any retrospective studies and randomised controlled trials that reported findings comparing the outcomes of the use of del Nido cardioplegia with that of St. Thomas cardioplegia were included. Results: We observed shorter aortic cross-clamp time (mean difference: −15.18, confidence interval: −27.21 to −3.15, p = 0.01) and cardiopulmonary bypass time (mean difference: −13.52, confidence interval: −20.64 to −6.39, p = 0.0002) associated with the use of del Nido cardioplegia in adult cardiac surgery as compared to St. Thomas cardioplegia. Defibrillation rates were significantly lower in patients who had been given del Nido cardioplegia, in both adult (relative risk: 0.28, confidence interval: 0.12 to 0.64, p = 0.003) and paediatric patients (relative risk: 0.25, confidence interval: 0.08 to 0.79, p = 0.02). Conclusion: Del Nido cardioplegia may be a viable alternative to the use of St. Thomas cardioplegia in both adult and paediatric patients, providing similar postoperative outcomes while also affording the additional advantage of shorter aortic cross-clamp time and cardiopulmonary bypass time (in adult cardiac surgery) and decreased rates of defibrillation (in both adult and paediatric cardiac surgery).

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Background: The current treatment for aortic stenosis includes open surgical aortic valve replacement (SAVR) as well as endovascular transcatheter aortic valve replacement (TAVR). This study aims to compare the 1-year, 2-3 year and 5-year structural durability of TAVR valves with that of SAVR valves. Method: A systematic literature search was conducted in July 2019 on Medline (via PubMed), Embase and Cochrane electronic databases according to the PRISMA guidelines. Results: Thirteen randomized controlled trials were included. From the meta-analysis, we observed higher rates of 1-year (OR: 7.65, CI: 4.57 to 12.79, p < 0.00001), 2-3-year (OR: 13.49, CI: 5.66 to 32.16, p < 0.00001) and 5-year paravalvular regurgitation (OR: 14.51, CI: 4.47 to 47.09, p < 0.00001) associated with the TAVR valves than the SAVR valves. There were also higher rates of 1-year (

Background Fractional flow reserve (FFR) is a well‐established method for the evaluation of coronary artery stenosis before percutaneous coronary intervention. However, whether FFR assessment should be routinely used before coronary artery bypass graft surgery (CABG) remains unclear. A meta‐analysis of prospectively randomized controlled trials (PRCTs) was carried out to compare the outcomes of FFR‐guided CABG vs coronary angiography (CAG)‐guided CABG. Method The meta‐analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Two PRCTs (the FARGO and GRAFFITI trials) were found and included reporting data on 269 patients with 6 and 12 month follow‐up. Primary endpoints were rates of overall death, MACCE, target vessel revascularization, and spontaneous myocardial infarction (MI). Secondary endpoints were overall graft patency and patency of arterial and venous grafts. Results There were no significant differences between the FFR‐guided and CAG‐guided groups in the rates of overall death, MACCE, target vessel revascularization, spontaneous MI and graft patency. Meta‐analysis of FARGO and GRAFFITI PRCTs showed that FFR‐guided CABG and CAG‐guided CABG produced similar clinical outcomes with similar graft patency rates up to a year postoperatively. Conclusion Currently available PRCTs showes no sufficient evidence to support the use FFR in CABG.

Background The optimal treatment strategy following a failed mitral valve repair remains unclear. This study aims to compare and analyse available studies which report the clinical outcomes post mitral valve re-repair (MVr) or replacement (MVR) after a prior mitral valve repair. Methods Based on PRISMA guidelines, a literature search was performed utilising PubMed, Cochrane and Scopus databases to identify retrospective cohort studies that reported outcomes of MVr and MVR after a prior mitral valve repair. Data regarding operative mortality, clinical outcomes and complications were extracted, synthesized and meta-analysed where appropriate. Results Eight studies with a total cohort of 1632 patients were used. After analysis, no significant differences in the short term and long-term operative mortality, incidence of stroke, congestive heart failure, Grade 1 and Grade 2 mitral regurgitation, requirement of 3rd mitral valve operation and reoperation due bleeding were found between the two groups. However, a slightly higher incidence of postoperative atrial fibrillation (OR: 0.11, CI: 0.02 to 0.17, I2 = 0%, p = 0.02) was observed in the MVR group, as compared to the MVr group. Conclusion MVr appears to be a viable alternative to MVR for mitral valve reoperation, given that they are associated with similar post-operative outcomes.

We examined the hypothesis that the short term clinical and angiographic outcome of skeletonized Left Internal Mammary Artery (LIMA) is better than that of pedicled LIMA used for revascularization of left anterior descending artery at CABG surgery at the Department of Cardiac Surgery, National Heart Foundation Hospital and Research Institute from May 2011 to April 2012. Accordingly we studied 60 consecutive patients who underwent coronary artery bypass grafting, in which the LIMA was anastomosed to the left anterior descending artery (LAD). In 30 consecutive LIMAs were harvested as a pedicle (Control Group) and another 30 consecutive LIMAs were harvested as skeletonized graft (Experimental Group). Three diameters of the LIMA graft were measured quantitatively in postoperative angiograms performed 6 ± 1 month after the coronary artery bypass grafting; D1, at the origin from the subclavian artery; D2, at the level of the second intercostal space; and D3, just proximal to the anastomosis. Our study shows that, complete skeletonization results in increased graft length 19.71 ± 1.77 cm in skeletonized group vs. 17.08 ± 0.71cm in pedicle group (p <0.001). Although there was similar incidence of superûcial wound complications between the groups, the post CABG pain (PCP) was significantly higher in pedicled group at the 6 month follow-up. Check coronary angiography showed the LIMA grafts to the LAD were all patent. There was increased diameter achievement in skeletonized group at the anastomotic site (D3: 1.78 ± 0.21 mm vs. 1.66 ± 0.18 mm; p = 0.03). We conclude that skeletonized LIMA showed a better functional behavior, giving longer conduit length and superior postoperative clinical and angiographic profile.

Background CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 132 patients between January 2016 and June 2018. Results In our study, the overall mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. Fifty-eight patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. After reviewed by the cardiologist blinded towards the study, we report trivial and/or mild paravalvular leak (PVL) in immediate post-operative echocardiography was found in 1 (1.01%) patients. There were no reported cases of valvular thrombosis, leaflet perforation, device dislodgement or embolization, moderate and/or severe PVL during hospitalization and follow-up echocardiography within 1 year. Single mitral valve and aortic surgeries had comparable incidences of post surgical complications. Conclusion We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.

Background: CORKNOT® facilitates a reduction in cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and operative time, but reported to be associated with other complications. We aim to quantify the incidence of valvular complications related to CORKNOT® and determine the feasibility of its use between different valvular surgeries. Methods: Patients who underwent heart valve repair or replacement surgery via the use of automated titanium suture fasteners (CORKNOT®) in a tertiary care hospital were included in the study. This single-centre retrospective study was conducted on 136 patients between January 2016 and June 2018. Results: In our study, the mean operative time was 320.0 ± 97.0 min, mean CPB time was 171.4 ± 76.0 min and the calculated mean ACC time was 105.9 ± 54.0 min. 58 patients (43.9%) underwent minimally invasive valve replacement or repair surgery and 66 patients (50.0%) underwent concomitant procedures. A total of 157 valves were operated on, with 112 (84.8%) single valve surgeries, 15 (11.4%) double valve surgeries and 5 (3.8%) triple valve surgeries. The incidence of moderate and/or severe paravalvular leak (PVL) in immediate post-operative echocardiography was found in 7 (5.3%) patients. There were no reported cases of valvular thrombosis leaflet perforation, device dislodgement or embolization during follow-up echocardiography. Single mitral valve and aortic surgeries had comparable incidences of valvular complications. Conclusion: We conclude the feasibility of CORKNOT® utilisation in mitral and aortic valve surgeries. Additionally, incidence of CORKNOT® related complications in heart valve repair or replacement surgery is less usual in our setting than previously reported. These results motivate the use of CORKNOT® as a valid alternative with complete commitment.