Aim: To compare post-operative in-hospital outcome of on pump CABG in patients with shorter CPB duration vs. patients with longer CPB duration. Methodology: In this cross sectional study conducted at Department of Cardiac Surgery, PIC, Jail Road, Lahore 182 subjects were selected using non probability Judgmental/ Purposive sampling Technique and randomly divided into two equal groups of 91 each. Group A: patients undergoing surgery for short duration of CPB < 90 minutes and half treated with Group B: patients undergoing surgery for long duration of CPB ≥ 90 minutes. Data was entered and analyzed using SPSS 25. Results: There were 133(73.08%) males and 49(26.92%) females in this study. The mean age of cases was 50.68±9.26 years with minimum and maximum age being 35 and 70 years. Mean Baseline Creatinine recorded for Group A was 0.92±0.19 and for Group B was 0.91±0.21. Mean urine output level recorded for Group A after 6 hours of CABG was 1.05±0.25 and for Group B after 6 hours of CABG was 0.85±0.24. There was a significant association in the occurrence of acute renal Injury in both groups whereas there was no significant association in the mortality of both groups. Conclusion: There was a significant difference between post-operative in-hospital renal outcomes of on pump CABG in patients with shorter CPB duration vs. patients with longer CPB duration. The results of both groups are nearly same as far as in-hospital mortality is concerned. Keywords: Cardiopulmonary Bypass, On Pump CABG, Off Pump CABG

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Aim: To compare the mean ejection fraction and cardiac enzymes level in patients with Ischemic heart disease undergoing elective coronary artery bypass graft surgery (CABG) having antegrade blood cardioplegia versus antegrade plus retrograde Cardioplegia. Study design: Randomized Controlled Trial Place and duration: This study was performed from 7th February, 2020 to 7th August, 2020 at the Cardiac Surgery Department, PIC, Jail Road, Lahore. Methodology: After receiving informed consent, all patients undergoing CABG were enrolled in this study. In order to compare the mean ejection fraction and cardiac enzyme levels between patients who had antegrade blood cardioplegia and those who had antegrade plus retrograde cardioplegia, preoperative, intraoperative, and postoperative characteristics were recorded into the predesigned proforma. Results: The total number of patients 72 was enrolled in this study who were divided into two groups. There were 36(50%) patients of who have given Cardioplegia through antegrade route while CABG and 36(50%) patients who have given Cardioplegia through antegrade plus retrograde route while CABG in this study. According to Table 1, the mean age of the patients in Group A was 51.86±9.35 years, whereas the mean ages of the participants in Group B 52.92±7.70 years. There were 26(72%) male and 10(28%) females in Group A and 30(83%) male and 6(17%) females in Group B. The mean BMI in Group A was 25.65±5.18 and 25.02±3.97 in Group B. There were 35(97%) hypertensive and 1(3%) non hypertensive patients in Group A and B respectively. Similarly, there were 33(92%) diabetic and 3(8%) non diabetic patients in Group A and 28 (78%) diabetic and 8(22%) non diabetic patients were in Group B. There were 26(72%) smokers and 10(28%) non- smokers in Group A and 24 (67%) smokers and 12(33%) non-smokers in this Group B. Practical Implication: The comparison of CKMB(IU/L) levels in Antegrade route group and antegrade plus retrograde group baseline and after 48 hours shows insignificant p-values of 0.17 and 0.12 respectively which shows that there is no significant difference in CKMB levels regarding these two routes chosen for giving Cardioplegia to patients undergoing coronary artery bypass grafting. Conclusion: Although both required additional surgical manoeuvres, however, the antegrade and antegrade plus retrograde cardioplegia approaches were equally effective and safe. Prior research demonstrated that multiple infusions offer superior protection to either antegrade or retrograde cardioplegia alone. Keywords: Coronary artery Bypass grafting surgery, Antegrade route, Retrograde Route, Antegrade plus Retrograde route.

Aim: To compare mean cardiac enzyme levels in of shorter cross clamp time V/S longer cross Clamp time in patients undergoing CABG in local population. Study Design: Randomized Controlled Trial Place and duration: This study was performed from 2nd April 2020 to 2nd October 2020 in the Department of Cardiac Surgery Punjab Institute of Cardiology, Lahore. Methodology: After informed consent, all patients undergoing CABG were enrolled and divided into two groups. A predesigned performa was used to enter preop, intra op and post op variables and cardiac enzyme levels were compared between shorter (<60 minutes) and longer (>60 minutes) aortic cross clamp time groups. Results: Study had enrolled 300 patients and 150(50%) patients were designated group A (shorter cross clamp time and 150 (50%) patients were designated in group B (longer cross clamp time). Out of these 300, 246 patients (82%) were males and 54 (18%) were females. Extremes of age were 70 years and 37 years and mean age was 56.77±8.03 years. Group A (shorter cross clamp time) patients had mean age of 56.64 ±7.53 and group B (longer cross clamp time) patients had 56.89±8.52 .Mean EF (%) was 52.17±8.98 with 23% being minimum and 70% being maximum. In group A patients, 93 patients (62%) were hypertensive , 82(55%) were smokers and 67 (45%) patients were diabetic, while group B had 110 (73%) hypertensive, 84(56%) smokers and 73(49%) diabetic patients. Mean CPB time in group A was recorded to be 93.72±29.97 and mean CPB time in group B was 121.04±31.83. The P-value was 0.001, significant enough to represent difference in CPG time in both groups Practical Implication: Additionally, no notable difference was found in need of inotropic supports between two groups. Longer cross clamp time is also associated with longer CPB time which in turn correlates with higher morbidity and mortality. Conclusion: It is concluded that prolonged cross clamp time is an independent predictor of morbidity despite cardio protection by modern strategies Keywords: CKMB, IABP, CABG, CPB time, aortic cross clamp time, Shorter Cross

In-hospital mortality rates have approved in the recent past1 6 to 12-month death persists at approximately 50%2. The goal of treatment is to reestablish tissue perfusion while closely monitoring hemodynamics. Provisional automatic cardiovascular support is a mainstay of the management of patients who cannot be stabilized with medical therapy. Apart from the acute setting, automatic cardiovascular support is also used in the mid- and long-term treatment of heart failure patients. This can either be until heart transplant or life-long in patents who are not candidates for heart transplant. Further it is an essential tool of open-heart surgery. In the present review we will give an overview and update of the different devices for mechanical cardiac support. Non-mechanical Cardio-Circulatory Support includes intravenous fluids and pharmacological treatment with vasopressors and inotropic agents. Norepinephrine is mainly a vasopressor, but also has other activities such as inotropy. It serves as first line agent, particularly in the acute setting of a cardiogenic shock. A recent randomized trial comparing Norepinephrine versus Epinephrine in cardiogenic shock after myocardial infarction found that Norepinephrine appeared to be a safer choice than Epinephrine3. Vasopressin causes less pulmonary vasoconstriction than norepinephrine and is therefore might better as a first line vasopressor compared to Norepinephrine4. Dobutamine, a beta agonist is frequently being used for cardiogenic shock, acting as inotropic agent. Levosimendan is a Calcium sensitizer and often used in patients with acute decompensation of chronic heart failure.