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Background: The hemodynamic instability during off-pump coronary bypass grafting (CABG) may impair the complete coronary revascularization. We evaluated the effect of off-pump CABG on intraoperative hemodynamic parameters. Aim of work: The purpose of this study is to assess the patients' hemodynamics during off-pump coronary artery bypass graft surgery. And the main challenge during the operation is to maintain hemodynamic stability during this procedure. Patient and Methods: We included 40 patients who underwent offpump CABG from 2017 to 2019. The mean age was 55.75± 6.73 years, and 28 patients were males (70%). The mean ejection fraction was 60.08 ± 3.81%. Study endpoints were the intraoperative hemodynamic parameters and postoperative complications. Results: Heart rate was significantly higher during the grafting of the posterior descending artery (PDA)(79.3± 2.8beats/min) and right coronary artery (79.5 ± 1.8 beats/min) compared to all other grafts (p<0.001). The highest central venous pressure(12.6± 1.2 mmHg)and mean pulmonary artery pressure (33.2± 1.4 mmHg) and the lowest mean arterial and pressure (68.1± 3.3 mmHg) were recorded during PDA grafting (p<0.001, for all parameters). There was no significant difference in adrenaline dose infused during the anastomosis of all grafts (p= 0.2). Ejection fraction significantly decreased predischarge (52.18 ± 2.58 %) and at 6 months (52.83 ± 3.57%) compared to the preoperative value (p<0.001). Conclusion: Off-pump CABG was associated with significant hemodynamic instability, which was more evident during the posterior descending artery grafting. Proper anesthetic management and fluid infusion are required, especially during the anastomosis of the right and posterior coronary systems.

Background: In repair of tetralogy of Fallot (TOF), the use of monocusp to protect the right ventricle from volume overload is debatable. Aim of the work: study evaluates early outcome of pericardial monocusp in pulmonary position in transannular patch repair (TAP).

Background: Reoperations after tetralogy of Fallot repair is common. This study aimed to report our indications, surgical procedures, and the clinical outcomes of patients undergoing reoperation after surgical correction of TOF. Patient and Methods: We included 40 patients who underwent reoperations after total TOF repair between 2015 and 2019. We included patients who had symptomatic right ventricular failure, patients with residual ventricular septal defect (VSD), right ventricular outflow tract obstruction (RVOTO), and tricuspid or pulmonary valve regurgitation. Results: The median age was 5.5(3.5-12.5) years, and 28(70%) were males. The median age at the time of primary repair was 2 (1-6) years. The end-systolic right ventricular (RV) volume estimated by MRI was 110.33±4.93 cc, and the end-diastolic volume was 208 ±10.08 cc. Twentytwo patients had VSD closure (55%), a transannular patch in 6 patients (15%), and RVOT resection in 14 patients(35%). Pulmonary valve replacement was performed in 6 patients(15%) and tricuspid valve repair in 4 patients (10%). The duration of postoperative mechanical ventilation was 11.5 (9-16.5) hours, and two patients had operative mortality (5%). Two patients (5%) had residual RVOT pressure gradient, and four patients had tiny residual VSD(10%). After six months of follow-up, four patients had moderate pulmonary regurgitation (PR), and four patients had residual VSD (10%). After one year follow-up, two patients had moderate PR(5%). Conclusion: A residual ventricular septal defect is a common indication for reoperation after the primary repair of tetralogy of Fallot. The results of reoperations are good with the accepted incidence of postoperative morbidity and mortality.

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