Introduction: In cardiac surgery, anaemia itself or combined with other risk factors has been found to be a major predictor for adverse outcome both preoperatively and postoperatively and even during extracorporeal circulation, but data about the specific tolerance of Coronary Artery Bypass Graft (CABG) patients for anaemia are conflicting and may in part be confounded by the effects of bypass surgery. Objectives: This study was performed in the National Institute of Cardiovascular Diseases (NICVD) to observe whether the early outcomes of Off-Pump CABG (OPCAB)were affected by pre-operative haematocrit levels. Methods: A total of 200 patients who underwent isolated OPCAB between January 2015 and December 2020 were retrospectively selected and purposively allocated into two groups: a)100 patients having preoperative anaemia and b) 100 patients without preoperative anaemia. Preoperative, per-operative and early post-operative variables were recorded, compiled and compared. Results: Preoperative characteristics were homogenously distributed between two groups other than haemoglobin level. Female patients had lower haemoglobin in each group. More patients of anaemic group required intraoperative and postoperative blood transfusion. The amount of blood loss and transfused blood products was also higher in anaemic patients. The ventilation time, length of ICU and post-operative hospital stay were significantly higher among anaemic patients. Among the post-operative complications, only the incidence of renal dysfunction was significantly higher among anaemic patients. Conclusion:This study has showed that anaemic patients undergoing OPCAB had an increased risk of postoperative adverse events. Importantly, the extent of preexisting comorbidities substantially affected perioperative anaemia tolerance. Therefore, preoperative risk assessment, optimization and subsequent therapeutic strategies, such as blood transfusion, should take into account both the individual level of preoperative haemoglobin and the extent of concomitant risk factors. Bangladesh Heart Journal 2021; 36(1) : 47-54
In-hospital mortality and morbidities are significantly higher in patients who undergo coronary artery bypass graft (CABG) surgery having a depressed left ventricular function or a left main (LM) coronary artery disease. Due to the improvement in technique and clinical outcome, Off-pump Coronary Artery Bypass (OPCAB) is thought to be beneficial in patients with depressed left ventricular function by avoiding prolonged ischemic time. This study was performed with an aim to assess whether OPCAB is better than conventional on-pump CABG (CCAB) in these sub-groups of patients. We purposively selected 100 patients with left main coronary artery disease (defined as ≥50% stenosis) with reduced left ventricular ejection fraction (defined as ejection fraction 40% or less) who underwent elective CABG in National Institute of Cardiovascular Diseases (NICVD) between January 2014 and December 2020. Among them OPCAB was done in 50 patients and conventional CABG in another 50 patients. Both groups had similar pre-operative parameters. Total operative time, intubation time, blood loss, requirement for blood and blood products, intensive care unit (ICU) stay and hospital stay were all significantly lower in the OPCAB group. Post-operative complications were not statistically different among the two groups. Study finds that patients with left main coronary artery disease with left ventricular dysfunction can be safely revascularized in OPCAB technique. Bangladesh Med J. 2021 Sept; 50(3): 14-19
:Homocysteine is an emerging new risk factor for cardiovascular disease. A common polymorphism in the gene coding for the 5,10-methylenetetrahydrofolate reductase (MTHFR) is associated with a decreased activity of the enzyme due to thermolability. There is an accumulating evidence that adequate intake of folate may protect the risk of developing the athero-thrombotic disease and its complications. Hyperhomocysteinemia (HCA)either due to mutation of MTHFR gene or deficiency of vitamin B12 and folic acid, has been reported as a risk factor for coronary artery disease (CAD).the present study was aimed to determine plasma homocysteine (hcy) levels and to evaluate MTHFR C677T gene polymorphism as risk factors for CAD in younger Indians. the effect of vitamin B12 and folic acid supplements on the raised plasma hcy levels in patients with CAD was also assessed. In our results, 6 cases are effected with a mutation in MTHFR gene. among them 4 individuals may face the future threat of myocardial infarction remaining 2 individuals are mutated and risk factors are similar to that of myocardial infarction.
Introduction: Left ventricular dysfunction is an important predictor of in-hospital mortality. Due to the theoretical and practical advantages to avoid the harmful effects of cardiopulmonary bypass (CPB), many cardiac surgeons are using Off-pump Coronary Artery Bypass (OPCAB)as an effective alternative to conventional CABG (CCAB) even in patients with reduced left ventricular (LV)ejection fraction. Objectives: This study performed in the National Institute of Cardiovascular Diseases (NICVD) evaluated the early outcomes of OPCAB in terms of mortality and major post-operative morbidities and compared them with that of CCAB in patients with multivessel coronary artery diseases and reduced left ventricular (LV) function. Methods: Total 120 patients with multivessel coronary artery disease with reduced left ventricular ejection fraction (d”50%)were allocated into two groups: a) 60 patients who underwent OPCAB and b) another 60 patients who underwent conventional CABG between January 2013 and December 2015. Pre-operative, peroperative and early post-operative variables were recorded, compiled and compared. Results: All risk factors and co-morbidities were homogenously distributed between the two groups. Majority of the patients had triple vessel disease. Nearly three-quarter (73.3%) of patients in OPCAB group and 80% in CCAB group received 3 grafts (p=0.470). The mean total operative time (268.5 ± 33.5vs. 296.3 ± 34.8minutes, p < 0.001), intubation times(8.6±0.3 vs. 12.3±0.5 hours, p<0.001), blood losses (377.8378 ± 45 ml vs. 602 ± 60 ml, p < 0.001); requirements for blood and blood products (689.7±21.1 vs. 1199.3±34.5ml, p < 0.0010),intensive care unit stays (31.7±0.9 hours versus 41.6±1.5 hours; p<0.001) and hospital stays (8.2 ± 0.2days vs.10.3 ± 0.3days, p < 0.001)were all significantly lower in the OPCAB group. Conclusion: OPCAB is a safe and effective operative revascularization procedure for patients with multivessel coronary artery disease and left ventricular dysfunction and is associated with reduced morbidity. However, a larger and omized trial with long-term followup may show the real benefits of OPCAB. Bangladesh Heart Journal 2020; 35(1) : 20-27
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