The incidence of acute kidney injury (AKI) after cardiac surgery remains high. The nonspecific adenosine receptor antagonist aminophylline has been shown to confer benefit in experimental and clinical acute renal failure (ARF) due to ischemia, contrast media, and various nephrotoxic agents. We conducted a prospective open label trial to assess the effectiveness of aminophylline for prevention of renal impairment after cardiac surgery. One hundred and thirty-eight patients undergoing cardiac surgery were risk stratified as per Cleveland score to assess for prediction of AKI. Sixty-three patients received a bolus aminophylline of 5 mg/kg and a subsequent continuous infusion of 0.25 mg/kg/h for up to 72 h, while 75 patients received usual postoperative care. Serum creatinine concentrations were measured preoperatively and daily until day 5 after surgery and the glomerular filtration rate estimated using Cockcroft and Gault formula. Hourly urine output was recorded and patients assigned to respective RIFLE stage of AKI. Cleveland score ≥6 was associated with higher incidence of AKI: I and F (P<0.005). Number needed to treat, an insight into the clinical relevance of a specific treatment, is 8. These results suggest that the perioperative use of aminophylline infusion is associated with lower incidence of deterioration in renal function following cardiac surgery in high-risk patients.

Background:Because of a concern about the ability of the heart to tolerate grafting on beating heart, patients with significant left main coronary artery stenosis (LMCA) have been excluded from off-pump bypass by many surgeons in their initial phase of experience. We reviewed our experience with off-pump coronary artery bypass grafting (OPCAB) for patients with critical LMCA disease and/or associated with co-morbid conditions.Methods: A total of 257 patients underwent CABG for significant (>50%) LMCA stenosis from January 2001 through October 2005. Of these, 131 patients (group 1) were revascularized on beating heart without use of CPB and 126 patients (group II) underwent CABG with use of CPB. In group 1,65 patients were high risk for CABG: 36 patients had critical (>90%) LMCA stenosis, 11 patients had severe LV dysfunction (LVEF < 35%), 7 patients had non-dialysis dependent renal insufficiency, 10 patients had COPD, 3 patients had h/o CVA, 5 patients were obese and 4 patients underwent re-operative CABG. 62 patients in group II were high risk for surgery. All patients had multivessel grafting performed through standard median sternotomy. Tissue stabilizers, intra coronary shunts and pericardial traction stich exposure techniques were used in all patients. Early outcomes were analysed and compared between the two groups.Results: The groups were similar in terms of demographic and preoperative risk factors. Offpump patients received less number of grafts compared to on-pump group (2.92 ± 0.8 vs 3.45 ± 0.83: p < 0.001). Inotropic requirement was higher in on-pump group (40/62 vs 30/ 65 : p 0.096), deterioration in renal function was less in OPCAB group compared to on-pump group (p 0.001). Requirement of blood transfusion was less in OPCAB group (p 0.0001). There was one death in on-pump group and none in OPCAB group (p 0.98) Conclusions: Coronary artery bypass grafting using off-pump technique is safe, effective and reproducible in patients with critical LMCA stenosis even in association with co-morbid conditions.

Aims and Objectives:In this study the efficacy of two betalactumbetalactamose inhibitor combination (used along with Ofloxacin and Amikacin) in prevention of gram negative ESBL producing bacterial growth (primary endpoint) and sepsis induced by them (secondary endpoint) has been evaluated.Methods: In a single blind RCT, 123 high risk patients (acute myocardial infarction, severe unstable angina and uncontrolled hyperglycaemia) undergoing CABG (without pump support) were evaluated for evidence of significant bacterial growth in ET-tube or throat swap, central line tip three days post hospitalization. For secondary endpoint, patients were examined for increased total leucocyte count, presence of toxic granules and sepsis (if present) was confirmed by procalcitonin assay. Patients were randomized by drawing of cards and were distributed into two groups. Group A comprising 45 patients received Amoxycillin clavulinic acid combination and Group B comprising 78 patients received cefoperazone-sulbactum combination. Primary and secondary end point results are evaluated for statistical significance using chi-square test and z-testing respectively.Results and Analysis: Of 45 patients in Group A-9 patients showed bacterial growth and 6 patients showed evidence of sepsis and in Group B-6 patients showed significant bacterial growth of whom 2 developed sepsis. Evaluating the numerical values for primary end point by chi-square test showed p<0.05 and secondary endpoint showed computed 'z' value to be greater than predicted value.Introduction: Elevated homocysteine is a known cardiovascular risk factor. Homocysteine, in blood, is metabolized by Methylene Tetrahydrofolate Reductase (MTHFR) enzyme. Mutation in MTHFR leads to increased homocysteine.Methods: We have analyzed 72 cases that underwent cardiac surgery. The cases were categorized into coronary artery disease (CAD, n=38), congenital heart disease (CHD, n=20) and rheumatic heart disease (RHD, n=14). 2 ml heparinised venous blood was collected from these patients prior to surgery for gene analysis. DNA was isolated and PCR for MTHFR gene was carried out using specific primers. The products were further restrict digested with Hin f I endonuclease. The products were then run on 4 % agarose gel to identify the polymorphism as homozygous normal (198/ 198 bp), heterozygous mutated (198/ 175 bp) and homozygous mutated (175 /175 bp).Results: In cases with CAD (n=38), 10.5% showed mutation. 10 % cases with CHD and 14.28% of RHD cases (n=14), showed the mutation. The results were analyzed with Fischer's test against the controls which showed 2.08 % mutation. The 'p' value was significant in cases with CAD, CHD and RHD (p < 0.05).Conclusions: Our study shows that MTHFR polymorphism is influencing the development of various cardiovascular events in patients and detection of the mutation will help in proper management of the patients.

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