CABG in left main desease with high risk euroscore-safe options

Abstract

Background: Echocardiography plays a vital role in assessing patients undergoing surgical ventricular restoration (SVR). Apart from measuring EF, wall motion abnormalities and valvular dysfunction, measurement of aorto septal angle (DJR angle), has both diagnostic and prognostic value.Methods: We analysed the echocardiogram of 25 consecutive patients who underwent SVR in our center. Systolic and diastolic frames of transthoracic echocardiograms, in parastemal long axis view are taken and the aorto septal angle is measured manually. Preoperative and postoperative angles of the same patients are compared to note the difference. This angle is compared with patients with normal left ventricular function as control.Results: In our series of 441 SVR, severe the ventricular dysfunction higher was the aorto septal angle. On the seventh postoperative day echocardiogram, the angle narrows by about 10 to 20 degrees. In the long term follow up the angle becomes near normal.Conclusions: Measuring aorto septal angle may be one of future cardiovascular surgeons armamentarium in patient selection and management of ventricular dysfunctions. Further research in this angle may reveal exciting results.Objectives: Over a period of five months ail patients requiring CABG were subjected to off PUMP CABG regardless of their risk factors such as poor LV, cardiogeuic sHock, etc. This was done to ascertain how many of them required pump support.Methods: 108 unselected consecutive patients are operated on beating heart by a single team of surgeons between Jan 2005. May 2005. 22 patients were ≥ 65 years of age, 46 patients were diabetics, LV function was poor (LVEF ≤ 30%) in 17 patients, redo surgery was performed in 3 patients, 7 patients undervent emergency revascularisation. 19 patients had COAD, preoperative renal dysfunction (creatinine clearance ≤ 40ml/min) was present in is patients and arrytllrnias (AF/frequent VPC) presem in 9 patients. Strategies used to prevent conversion to on pump were i> Pre operative pharmacological manipulation ii> Intraopertaive prevention of arrylhmias iii> Technical manipulation in large heart by using star fish positioner iv> RV filling was achieved by tilling head end downwards instead of fluid infusion v> In gross cardiomegaly requiring grnfting to left circumflex branches, left thoracab was preferred vi> Special technique was used to dissect intramyocardial arteries on beating heart. Results: Out of 108 patients, only 3 patients were convened to pump support (2.72%, one case of redo). There was no evidence of periopertaive myocardial infarction based on ECG and cardiac enzyme, changes. One patient had reexploration for bleeding and one patient expired due to sepsis and there was no neurological problem. Survivors were discharged from the hospital between 7-8 days post operatively.Conclusions: In patients willI CAD. OPCAB can be performed with an acceptable mortality and morbidity. By using a definite set of strategies, conversion to pump support in OPCAB patient can be reduced to less than 3%. 113Coron...