As the world advances, living standards are getting changed with inclination more toward sedentary life style and junk food, we are seeing a worldwide increased incidence of coronary artery disease. A 73 year of age gentleman with progressive shortness of breath NYHA-II/III since last 6 months and epigastric discomfort with effort angina CCS-III. Was having no other co-morbidities, except of 35 pack years of smoking. On evaluation his Coro-angiogram revealed Diffuses TVCAD with Lad diffusely diseased throughout its middle course >90%, LCX 80%, RCA mid-Course critical discrete lesion of 90%. His 2D, TTE showed normal valvular apparatus and ejection fraction of 55%. Literature review further furnishes the fact that LAD is most commonly being affected by atheroma formation hence making it the most common site for endartrectomy, though peri-operative MI is still a grave concern, but half dose protamine slow reversal of the heparin and keeping ACT at 150-160 sec greatly reduces the incidence of peri-operative MI.

Objective: To compare the incidence of sternal wound dehiscence between simple interrupted vs. figure-of-eight sternal closure techniques for median sternotomy in patients undergoing coronary artery bypass graft surgery. Study Design: Comparative prospective, randomized control trial. Place and Duration of Study: Study conducted at Department of Cardiac Surgery, Armed Forces Institute of Cardiology Rawalpindi, from Apr to Dec 2019. Methodology: A total of 206 patients were included in study. These patients were divided into two groups; group “A”: cases which will undergo simple interrupted sternal wire closure technique (n1=103). Group “B”: cases which will undergo figure-of-eight sternal wire closure technique (n2 = 103). Results: There were no statistical difference in the pre-operative data of the patients. The incidence of sternal wound dehiscence in simple interrupted closure was 6.79% while in figure of eight closure technique it was noted to be 1.94%. A statistically significant difference was noted in both the closure technique (p<0.05). Conclusions: Figure-of-eight sternal wire closure technique provides better strength and stability to sternum along with reduced incidence of sternal wound dehiscence as compare to simple interrupted wire closure.

Objective: To compare the clinical outcomes of mitral valve surgery through right minithoracotomy versus median full sternotomy. Study Design: It was a comparative cross-sectional study Place and Duration of Study: Carried out at the Armed Forces Institute of Cardiology/National Institute of Heart Diseases(AFIC/ NIHD). Data was gathered from hospital database from Dec 2013 to Mar 2020. Methodology: From December 2013 to March 2020, 721 patients with various mitral valve diseases were treated at our institute with isolated mitral valve surgery. 50 patients had (MIMVS). 670 patients, on the other hand, underwent conventional median full sternotomy (MFS) mitral valve surgery. We selected 50 MFS patients with similar age, gender, Euro Score, NYHA functional class, Left ventricular ejection fraction (LVEF), mitral valve disease grade, renal and liver function. The outcome variables chosen for this study were cross clamp time (CXT), cardio pulmonary bypass (CPB) time, intensive care unit (ICU) stay, postoperative pain, and Length of stay (LOS). Results: The majority (n=42, 84%) of MIMVS group patients had CPB time between 122-201 minutes, whereas, majority (n=33,66%) of MFS group had CPB time between 81-134 minutes. In MIMVS group maximum number of the patients (n=36,72%)had ICU stay of 50-70 hours duration, whereas, in MFS group, maximum number of patients (n=40,80%) stayed in ICU for 10-30 hours duration. The mean CX time for MFS approach was 72.08 minutes while that for MIMVS was 96.9 minutes. Similarly,the median and mode for MFS were 68.5 minutes and 47 minutes respectively. Pain after surgery plus subsequent overall hospital length of stay (LOS) were reduced in MIMVS group. Conclusions: MIMVS is related with elevated CPB and CXT, which subsequently resulted in longer ICU stay while reduced post-operative pain lead to decrease in overall hospital length of stay.

Objective: To compare cardiac troponin-I levels in post-operative period of on-pump (ONCAB) versus off-pump coronary artery bypass surgery. Study Design: Prospective Observational Study. Place and Duration of Study: Armed Forces Institute of Cardiology, from Jan 2019 to Dec 2019. Methodology: This prospective observational study was done at Armed Forces Institute of Cardiology from 1st January 2019 to 31st December 2019. Eighty six (43 in each on-pump and off-pump) patients admitted for elective coronary artery bypass grafting, aged 30-80 years were included in the study. Baseline data and cardiac troponin-I levels preoperatively as well as at 6, 12, 18 and 24 hours after the surgery in both groups were recorded and analyzed. Results: Out of 100 patients, mean age of the patients was 57.59 ± 10.24 years and 85% were males. All the base line characteristics, comorbid conditions and intra-operative findings were identical in both groups. There was marked rise in CK-MB levels postoperatively in overall participants. There was significant rise in Troponin I levels postoperatively in overall participants. Compared to OPCAB, postoperative Troponin I at 6hours and 12-hours was significantly higher in ONCAB. Conclusion: Compared to OPCAB, postoperative Troponin I at 6 hours and 12-hours was significantly high in ONCAB. However, there was no gross discrepancy in postoperative Troponin I levels between OPCAB and ONCAB at 18- & 24-hours after surgery.

Objective: To compare the early outcome of Coronary Artery Bypass Graft surgery using a combination of antegrade and retrograde cardipoplegia with that utilizing antegrade cardioplegia alone in triple vessel coronary artery disease. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Adult Cardiac Surgery of Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, from Sep 2013 to Apr 2019. Methodology: A total of 160 patients with triple vessel coronary artery disease who underwent CABG surgery for 90% or greater stenos is in at least one major vessel in each of the three territories, namely the left anterior descending, the circumflex and the right coronary artery were investigated retrospectively. These were divided into 2 equal groups on the basis of the technique of administration of cardioplegia: in group-1 only ante grade blood cardioplegia was administered for myocardial protection and group-2 was given ante grade and retrograde cardiolplegia. Clinical outcomes like peri-operative mortality and morbidity were recorded, and serum creatine kinase MB, lactate, and mixed venous oxygen saturation levels were monitored. Two dimensional echocardiogram was performed on the 6th post-operative day and follow-up visits were planned 1 week and 4 weeksafter discharge from hospital. Results: There were 2 (2.5%) early deaths in group-1 and no peri-operative mortality in group-2. Five patients in group-1 (6.25%) and 2 (2.5%) in group-2 had non-fatal peri-operative myocardial infarction. However, significant differences included increased incidence of intra-operative ventricular dysrythmias, higher CK-MB levels at 24 hours after surgery, and increased requirement of intra-aortic balloon pump and inotropic support in Group-1. Conclusion: We conclude from this study that the combined delivery of ante grade and retrograde cardioplegia during CABG surgery for triple vessel coronary artery disease provides better myocardial protection and hence better outcome than antegrade cardioplegia alone.Keywords: , , ,